
Class_3v(L$fel_ 
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PRESENTED BY 






Colon Hygiene 



Colon Hygiene 



Comprising New and Important Facts Con' 
cerning the Physiology of the Colon and an 
Account of Practical and Successful Methods of 
Combating Intestinal Inactivity and Toxemia 



J. H. KELLOGG, M. D., LL.D. 

Superintendent of the Battle Creek Sanitarium; Author of "Neurasthenia, 

Its Causes and Cure," "Rational Hydrotherapy," "The Art of 

Massage," "Light Therapeutics," etc. 



Twenty-eighth Thousand 



BATTLE CREEK. MICHIGAN 

GOOD HEALTH PUBLISHING CO. 

1917 






Copyright 1917 

BY 

J. H. KELLOGG 

Gift from 
Robert L Owen 
Nov. 4, 1931 






Preface 



That most despised and neglected portion of 
the body, the colon, has in recent years been made 
the subject of much scientific study and research, 
with the result that a lively controversy has been 
stirred up over the question as to whether this or- 
gan should be permitted to remain a part of the 
"human form divine," or whether it should be 
cast out as worse than useless and unworthy of a 
place in the anatomy of the modern genus homo. 

Anatomists have declared the colon to be a 
useless appendage, a vestigial remnant left over 
from a prehistoric state. Bacteriologists have 
charged it with being an incubating chamber of 
poison-forming germs, a hold of unclean and hate- 
ful parasites, a veritable Pandora's box of disease 
and degeneracy. Surgeons have removed the offend- 
ing organ, and thus proved that it may be dispensed 
with, and have claimed wonderful advantages from 
this abbreviation of the prima via. 

Barclay Smith, the great English anatomist, first 
suggested the uselessness of the colon. MetchnikofI 
proved that animals that possess the longest 
colons have the shortest lives, and announced that 
the colon bacillus is the germ of old age. Sir 
William Arbuthnot Lane, the eminent London 
surgeon, cites a long list of grave maladies, ranging 



10 PREFACE 

from tuberculosis to rheumatism, cured by removal 
of this offending organ. 

The war still wages. There are pro-colon par- 
tisans as well as anti-colon enthusiasts. One thing 
is certain, however, the colon can no longer be 
ignored. That this organ, or rather the morbid 
conditions that develop in it, plays a dominant role 
in the causation of a long list of the gravest and 
most common disorders, can no longer be denied. 

In the treatment of every chronic disease, and 
most acute maladies, the colon must be reckoned 
with. That the average colon, in civilized com- 
munities, is in a desperately depraved and danger- 
ous condition, can no longer be doubted. The 
colon must either be removed or reformed. From 
the beginning of the colon controversy and for 
many years before, the writer has been a very 
earnest student of the questions involved, and has 
formed very definite opinions, the validity of 
which he, together with his colleagues of the fac- 
ulty of the Battle Creek Sanitarium, has had oppor- 
tunity to test in the treatment of many thousands 
of sufferers from colon and colon-caused maladies. 
The writer believes that methods have been worked 
out by means of which the colon may be reformed 
and made to do its work efficiently, not only in 
ordinary cases, but in by far the great majority of 
those cases which are thought by enthusiastic colon 
surgeons to be suitable subjects for surgical treat- 
ment. 



PREFACE 1 1 

Until very recent years almost nothing has been 
known of the physiology of the colon. This part 
of the body has been almost a terra incognita. The 
physiology of digestion stopped at the ileocecal 
valve. How the colon dealt with its contents, how 
the very necessary act of defecation was performed, 
nobody knew. The discovery of the X-ray en- 
abled Cannon and, later, Hertz to study the colon 
while in action in animals and man. Elliot, Keith, 
and other anatomists studied the intestine in dogs, 
and finally Case, by perfecting the X-ray technic 
of colon examinations, completed the physiologic 
study of this previously neglected organ. The 
combined result of the extensive labors of these 
investigators has been a great flood of light upon 
some of the most obscure questions in physiology. 
These new facts, not yet known to the general 
public, have rendered the greatest service in the 
development of rational methods of dealing with 
that most common and most destructive disease of 
civilized peoples — constipation. The chief purpose 
of this work is to present in a popular way these new 
facts and the practical results to which they have 
led. 

Forty years' experience and observation in deal- 
ing with chronic invalids, and careful study of 
the results of the modern X-ray investigations of 
the colon, together with observations made at the 
operating table in many hundreds of cases, has 
convinced the w r riter — 



12 PREFACE 

1. That constipation with its consequences is 
the result of the unnatural habits in relation to diet 
and colon hygiene which prevail among civilized 
people. 

2. That patients are not constipated on gen- 
eral principles, but that there exists in every case 
of constipation some particular condition which is 
the immediate cause of the delayed intestinal move- 
ment, and which must be removed before definite 
relief can be obtained, and that in the great ma- 
jority of cases this cause is mechanical in character, 
a fold, a kink, a redundancy, a contraction — in 
short, some real and tangible obstruction. 

3. That practically every case of constipation 
is curable, and in all but exceptional cases without 
the aid of surgery. It must be added, however, 
that by cure is not meant the working of such a 
miracle that the colon will perform its function 
normally without attention to diet or other means 
which encourage colon activity, but rather that by 
observing certain rules and the faithful and con- 
tinuous use of safe and simple means, the colon 
may be made to perform its functions in a regu- 
lar and efficient manner, without the use of 
irritating laxative drugs. 

If some of our recommendations at first impress 
the reader unfavorably, we ask only that judg- 
ment be suspended until the suggestion has been 
given a fair test in actual experiment. Every 
measure presented has been tested in the crucible 



PREFACE 13 

of actual experience in hundreds of cases, and is 
the result of a long series of practical tests made 
for the purpose of determining the actual value of 
individual remedies and perfecting practical methods 
of relief. 

If the reader misses the usual list of laxative 
drugs, old and new, the reason is simply that 
the writer regards all medicinal agents that force 
bowel action by irritation (wrongly termed "stimu- 
lation") as pernicious and, without exception, harm- 
ful, and to be used only as temporary or emerg- 
ency measures. In the words of the eminent Pro- 
fessor Von Noorden, "Nothing is so bad as the 
chronic use of laxative drugs." 

The reader is asked especially to note that no 
panacea is offered for colon miseries; there is no 
"cure all" for constipation. The way out of the 
slough of intestinal toxemia with its "biliousness," 
headaches, neurasthenias, and multitudinous mal- 
adies, is to be found only through living biolog- 
ically, and making use of the "safe and sane" helps 
which recent scientific progress has provided. 

In attempting to put into semi-popular form the 
scientific facts pertaining to the hygiene of the colon, 
the writer does not desire to convey the impression 
that the sufferer from severe constipation can 
safely undertake to act as his own physician. The 
purpose is rather to enable the patient who may 
read this work to cooperate intelligently with the 
wise up-to-date physician. 



14 PREFACE 

The reader's attention is especially called to the 
chapter on "The Bowel Habits of Uncivilized 
Man," which contains a fund of original informa- 
tion obtained at the cost of much effort, which is 
both highly interesting and instructive. The author 
desires here to acknowledge his obligations to some 
hundreds of medical colleagues who have devoted 
their lives to the noble work of carrying to heathen 
lands the blessings of modern scientific medicine and 
Christian civilization, and who have found time in 
the midst of their arduous labors to answer the 
questionaire and thus furnished the unique informa- 
tion presented in this chapter. 

PREFACE TO FOURTH EDITION 

REVISED AND ENLARGED 

The writer has made a few important additions 
in this edition of "Colon Hygiene." The author 
also desires to express his gratitude for the very 
kindly reception which the book has received and 
the hope that the revisions made in this fourth edi- 
tion will render the volume still more useful and 
acceptable to those of the great army of sufferers 
from chronic ailments into whose hands the work 
may fall. 



Contents 

The Colon 17 

The Physiology of the Colon 23 

The Ileocecal Valve and Its Function . . 37 

Normal Bowel Action ... ... 40 

The Feces 51 

Influences Which Excite Movements of the 

Colon 58 

Influences Which Lessen Intestinal Move- 
ments . 73 

The Causes of Constipation 78 

Habits Which give Rise to Constipation . 87 
Disorders of the Digestive Tube . . . . 135 
Alimentary Toxemia, or Intestinal Autoin- 
toxication 159 

Important Discussion of Alimentary Toxemia 

before the Royal Society 177 

Forms of Constipation 195 

The Treatment of Constipation .... 201 

Diet in Constipation 218 

Baths and Other Home Treatments for Con- 
stipation 241 

Exercises Which combat Constipation . . 272 



16 CONTENTS 

Efficient Electrical Methods 300 

Special Treatment of Different Types of Con- 
stipation 303 

Treatment of Disorders Which Result from 

Constipation 322 

Bowel Habits of Uncivilized Man . . . 370 



The Colon 

Ignoring technical anatomical details the food 
canal may be described as a muscular tube about 
ten times the length of the body, measuring the 
trunk from the top of the head to the end of the 
spinal column. The chief part is coiled up in the 
lower cavity of the trunk, below the diaphragm. 
The upper end of the canal is controlled by the 
circular muscle of the lips, which is brought strongly 
into play in whistling. The lower end is controlled 
by the anus, also a voluntary circular muscle. At 
other points along the canal, circular muscles are 
placed to regulate the movements of the foodstuffs 
during the process of digestion. Both in health and 
disease these "food gates," as they may be called, 
have a most important relation to digestion that has 
not been fully appreciated until very recent times. 

The upper end of the food tube is provided with 
a special apparatus, the mouth and teeth, for taking 
in food and preparing it to undergo the various 
processes which are carried on in the deeper parts. 
At the lower end of the canal is found a mechanism 
that is wonderfully designed to receive and discharge 
from the body the unused remnants of the food and 
other waste materials — the pelvic colon. Of this 
we shall learn more later. 

17 



18 COLON HYGIENE 

The Structure of the Food Tube 

In structure, the food tube consists chiefly of 
muscle and gland tissue. There are two sets of 
muscle fibres. One set, the outer, runs lengthwise 
of the canal; an inner, circular muscle structure, 
surrounds the canal throughout its entire length. 

Between the muscle layers is a layer of nerve 
cells and fibres. These are connected with the 
central nervous system, the brain and spinal cord, 
but are capable of acting independently. 

The food canal is lined with mucous membrane, 
which presents at various points special groups of 
glands that produce some of the various digestive 
juices which act upon the food. The canal is cov- 
ered through most of its course with a delicate 
membrane, the peritoneum. 

The food tube is roughly divided into six parts — 
the mouth, oesophagus, stomach, small intestine, 
colon and rectum. The intestine is attached to 
the spine by a membrane, the mesentery, in which 
pass the nerves and blood vessels which supply the 
canal. 

The colon may roughly be described as a mus- 
cular reservoir about five feet in length and an inch 
and a half to three inches in diameter. This reser- 
voir is divided into four secondary reservoirs, the 
cecum, the transverse colon, the pelvic colon, and 
the rectum. The feces, in their preparation for 
discharge from the body, are passed successively 
from one to the other of these reservoirs, pausing 




2 c 





u 





THE COLON !9 

for a definite interval in each, with the exception of 
the last. 

Normal Position of the Colon 

When in its normal position, the colon begins 
at the lower right hand section of the abdominal 
cavity; its head, a pouch much broader than the 
rest of the colon, lies in the hollow of the right 
iliac bone. This is the cecum. The small intes- 
tine joins the cecum about an inch and a half 
above its lower part, leaving a pocket, at the bottom 
of which is attached the appendix. 

From the cecum the intestine ascends along the 
right side of the abdomen to the liver. This por- 
tion is the ascending colon. At the liver a rather 
sharp turn is made toward the left, the hepatic 
flexure. 

From this point the colon passes across the body 
above the umbilicus, sloping upward toward the 
left side, where it lies in close contact with the 
spleen. This section is the transverse colon. 

At the spleen the intestine makes a short turn, 
the splenic flexure, then passes downward along 
the left border of the abdominal cavity to the hip 
bone (crest of the ileum). This is the descend- 
ing colon. 

Passing obliquely across the hollow surface of 
the left iliac bone, the large intestine, here called 
the iliac colon, reaches the upper border of the 
pelvic cavity. Here it forms a loop, the pelvic 



20 COLON HYGIENE 

colon, which has an average length of a foot and 
a half, but which varies in length from six inches 
to nearly three feet (in conditions of disease). The 
pelvic colon and iliac colon together form the sig- 
moid. The lower end of the pelvic colon joins 
the terminal portion of the intestine, the rectum, 
opposite the middle of the sacrum. The pelvic 
colon varies in position according as it is empty or 
filled. When empty, it falls over backward into 
the pelvis, and lies upon the upper part of the 
rectum. When it is in this position, a very pro- 
nounced fold is formed at the junction with the 
rectum, the pelvi-rectal fold, a factor in con- 
trolling bowel movements. When the pelvic loop 
is full, it rises and thus gradually obliterates the 
fold and so opens the passage to the rectum. 

The rectum extends from the pelvi-rectal fold 
to the internal anal sphincter, being about six inches 
in length. In its upper part are two or three 
projecting folds of membrane known as Houston's 
valves. 

The thicker muscular walls of the rectum are 
ordinarily contracted so that no cavity exists in 
the upper part, although some gas and often (in 
cases of disease) a considerable amount of fecal 
matter may be found in the lower part. 

The distance between the internal and external 
sphincter is about one inch. This is the anal 
canal, which is always tightly closed except dur- 
ing defecation. 




longer fc.el. 
Valve; C, Colon. 



THE COLON 21 

Just above the internal anal sphincter is found 
a series of raised points or papillae, first described 
by Horner of Philadelphia many years ago. These 
papillae are the terminal points of special nerves 
which when excited cause powerful contraction of 
the colon and the abdominal muscles and dia- 
phragm, and at the same time a complete relaxation 
of the anal sphincter. 

Here are also a number of shallow pockets in 
the mucous membrane, the follicles of Horner, 
whose function is to secrete a lubricating mucus. 
Both follicles and papillae sometimes become in- 
flamed and a source of pain. 

Behind the rectum are located two muscles 
which act an important part in defecation, the 
levator ani muscles. In contracting, these muscles 
pull the anus upward and compress the rectum, 
and so squeeze out the last particles of fecal matter, 
leaving the rectum completely empty. 

The small intestine is a smooth tube of uniform 
size, but the large intestine is sacculated. By a 
thickening of its muscular structures at intervals 
shallow pouches are formed in its sides. Along the 
outer surface of the colon run thick bands of 
muscle tissue which act in defecation like gathering 
strings. In contracting, these bands draw the lat- 
eral pouches together, so as to empty them of their 
contents. These sacs or pouches are well shown 
in the accompanying stereoradiogram, a rare view 
of the colon. 



22 COLON HYGIENE 

All parts of the large intestine, including the 
rectum, are supplied with two sets of nerves, one 
of which stimulates its muscles to contract, while 
the other exercises an opposite influence. 

In the accompanying plates will be seen represen- 
tations of the colons of different animals. It is 
especially interesting to note the close relation be- 
tween the form of the colon and the character of 
the food in various classes of animals. In flesh- 
eating animals the colon is always short; in vege- 
table eaters it is long as compared with the body 
length. 



The Physiology of the Colon 

The function of the colon is largely that of 
a receptacle for unusable and waste matters, a sort 
of human garbage box. On this account, perhaps, 
this part of the food tube has been habitually neg- 
lected. It has been regarded as of little conse- 
quence. But modern studies of this part of the 
intestine have shown that by neglect this temporary 
reservoir of wastes may become a veritable breed- 
ing place of miseries and maladies almost too num- 
erous to mention. So many and so serious are the 
disorders of mind and body which are now trace- 
able to this part of the food tube, that not a few 
eminent surgeons have advocated and practiced the 
actual removal of the colon in cases of chronic 
disease of various sorts, and in many instances with 
surprisingly good results. 

Professor Metchnikoff, of the Pasteur Institute, 
Paris, Dr. Arbuthnot Lane, head surgeon of Guy's 
Hospital, London, Dr. Barclay Smith, and numerous 
other scientific men, eminent bacteriologists, physi- 
ologists, anatomists and surgeons, have even an- 
nounced the belief that the colon is a useless and 
often dangerous structure and that it may be advan- 
tageously dispensed with. 

The writer does not accept this view, but holds 
with Professor Keith, the eminent English anatom- 
ist, that the evils attributed to the colon are really 

23 



24 COLON HYGIENE 

due to the adoption by man of a dietary unsuited to 
his anatomy. All vegetable-eating animals have 
long colons, as has man. The presumption is that a 
vegetable diet requires a long colon. Meat-eating 
animals, as the dog, have short colons. The frog 
while in the tadpole state is a vegetable feeder and 
has a very long colon. The adult frog feeds upon 
flesh and has a very short colon. 

The Wrong Use to Which We Put the Colon 

The trouble with the civilized colon is not that 
it is too long, but that it is put to a wrong use. 
Civilized man has adopted the dog's diet while 
having the colon of the chimpanzee. It may be ad- 
mitted that if a man is to feed on the diet of the dog 
he ought to have his colon abbreviated. This is, in 
fact, the only way in which he could avoid a dan- 
gerous biologic misfit. 

It is hardly to be supposed, however, that Nature 
has made so grave an error as to give to man an 
organ which is not only a useless appendage, but 
at the same time a prolific source of mischief. It 
seems more rational to believe that if the colon, 
an organ useful under normal conditions of life, is 
found to be so great a source of mischief in our 
civilized life, it is because of abnormal and pernic- 
ious habits or other influences connected with the 
life of the average civilized man. 

The remedy is to be sought then, not in the 




Diagram Showing Normal Colon and 
Ileocecal Valve 



THE PHYSIOLOGY OF THE COLON 25 

extirpation of a portion of the body, but in a cor- 
rection of those habits of life in which there has 
been a departure from the condition normal to 
the human species, and a return to practices and 
conditions which are physiologically and biolog- 
ically correct for the genus homo. 

The First Function of the Colon 

One important function of the colon is to re- 
ceive and to discharge from the body the unusable 
residue of foodstuffs. If these foodstuffs are of 
such a nature that they readily undergo putrefac- 
tion, as do meats of all sorts, the colon contents 
will become highly putrescent, offensive and poison- 
ous, while still in the body. A non-putrefying 
vegetable diet on the other hand furnishes a residue 
which cannot putrefy, but ferments, forming harm- 
less acids which aid bowel action. Hence the colon 
is not out-of-date, as its critics have suggested, but 
is only made to appear as a misfit by the adoption of 
a diet which belongs to short-colon animals. This 
view maintained for many years by all advocates of 
the biologic diet is so eminently reasonable that it 
cannot fail to be accorded due recognition since it is 
now supported by so eminent an authority as the 
world-famous anatomist, Professor Keith, of Eng- 
land. 

Another important function of the alimentary 
canal, one which is quite distinct from its function 



26 COLON HYGIENE 

as a digestive apparatus, is its excretory function. 
The intestine is the outlet of the bile, from fifteen 
to twenty ounces being poured into the upper end 
of the small intestine every twenty-four hours. The 
bile is the most poisonous of all the bodily secretions, 
being, according to Bouchard, six times as poisonous 
as urine. It is through the bile that the body rioV 
itself of alkaline wastes, some of which are highly 
poisonous in character. 

Another fact of very great importance is that the 
intestine is itself an excretory organ. Certain poi- 
sons are excreted by the stomach, others find their 
way out of the blood through the walls of the gall- 
bladder and the small intestines. 

The colon forms a receptacle for all these waste 
and excretory substances, together with the un- 
usable or undigested residues of the food. But 
the collection of these waste matters is only an 
incidental function of the colon, its really important 
function being to conduct these waste and unusable 
matters out of the body. 

The food normally enters the first part of the 
colon, or the cecum, in a nearly fluid state, its 
composition being ninety per cent water, and only 
one-tenth solid matter. During the passage of 
the foodstuffs through the twenty-two feet of small 
intestine, the digestible starches, fats, and proteins 
are rendered soluble by the digestive fluids, and are 
practically completely absorbed. The solid parts 
left consist almost entirely of indigestible remnants 



THE PHYSIOLOGY OF fHE COLON 27 

of foods, waste products excreted by the liver and 
the intestinal mucous membrane and microbes which 
are produced in great numbers in the lower part 
of the small intestine as well as in the colon. 
The small intestine is not only the seat of the 
principal digestive processes, but is also the prin- 
cipal organ of absorption of the digested foodstuffs. 
The colon normally absorbs only about one-sixth of 
the water which remains in the material received 
from the small intestine, the amount of which is 
estimated at about half a pint, and practically none 
of the foodstuffs. The small intestine absorbs daily 
five or six quarts of liquids and all the products of 
digestion. It is, in fact, the one great avenue for 
the intake of nutrients, both solid and liquid. 

About four hours after a meal, bubbling and 
squirting sounds may be distinctly heard when the 
ear is placed over the right lower abdomen, and an 
hour or two later it is easy to produce splashing 
and gurgling sounds by intermittent pressure over 
the colon low down in the right side of the abdo- 
men, showing that a considerable amount of fluid 
has passed from the small intestine into the cecum. 
It should be remembered that this is not a mere 
mechanical process. The fluid food does not pass by 
gravity from the small bowel into the large intestine 
as water might trickle from a pipe into a reservoir. 
The opening of the small intestine into the colon is 
controlled by a sphincter, the ileocecal valve. This 
circular muscle holds the food in check in the lower 



28 COLON HYGIENE 

part of the small intestine long enough to make 
sure that digestion is complete and the absorption 
of digested foodstuffs practically finished. In other 
words, the ileocecal valve is a sort of second pylorus, 
and serves much the same purpose. 

The pylorus and ileocecal gates hold back solid 
and imperfectly digested foodstuffs, permitting the 
fluid portion to pass on. In the cecum and ascend- 
ing colon the food is detained by a special process, so 
that its fluid portion may be absorbed, thus increas- 
ing the consistency of the bowel contents. Gradu- 
ally a portion of the water is taken up by the absorb- 
ents, which are very numerous in this part of the 
colon, and at the same time the more solid portions 
are pushed along toward the upper end of the as- 
cending colon, the fluid part dropping back into the 
cecal pouch for absorption. 

Keith, the eminent English anatomist, has re- 
cently pointed out new facts of great interest in re- 
lation to the control of the movements of the ali- 
mentary canal. Keith has shown that the muscular 
structures of the intestine have the same property 
of rhythmic action as is possessed by the muscle 
fibres of the heart. This tendency to rhythmic 
movement of the individual fibres is an organized, 
orderly action of certain centers or nodes which are 
designated as pace makers. These nodes have been 
shown to exist at the following points along the 
alimentary canal — the upper or cardiac orifice of 
the stomach, the pylorus, the duodenum, the ileo- 






THE PHYSIOLOGY OF THE COLON 29 

cecal valve, the transverse colon, the junction of the 
pelvic colon, the rectum and the internal anal 
sphincter. . 

Movements of the Colon 

Like the stomach, the colon has movements pe- 
culiar to itself, — four very distinct modes of con- 
traction. These are: 

1. Molding movements, by which the contents 
are slowly compressed and molded. These move- 
ments are almost too slow to be noticed by the 
eye in X-Ray examinations except by observations 
made at intervals of a half hour or more. 

2. Propulsive movements, by which the colon 
contents are passed along so rapidly that the eye 
cannot follow the movement. Movements of this 
sort occur regularly when the bowels are evacuated 
and also at other times. 

3. Snake-like movements. Roeder, of Germany, 
has recently described movements in which the 
transverse or free part of the colon moves about 
in a manner closely resembling the contortions of a 
serpent. From this he concludes that the position 
of the transverse colon, unless it is held fast by 
adhesions, is not a definite one and is not a matter 
of much importance. 

4. Reverse Peristalsis. Anti-peristalsis, that is, 
a reverse movement of the intestine, was first 
observed by Jacobi, more than twenty years ago, 
and has more recently been studied in cats by Can- 



30 



COLON HYGIENE 



non. These movements occur systematically while 
the contents of the cecum are fluid in character, and 
serve both to prevent the sudden and frequent dis- 
charge of the bowel contents, as in diarrhoea, and 
also to churn the contents of the cecum, thus bring- 
ing every portion in contact with the walls of the 
gut, so that absorption may be assisted. 

As studied in animals, by Cannon, and in human 
beings by Case, the rhythmical reverse movements 
which occur in the colon, never in the small intes- 
tine, are interrupted at regular intervals by a down- 
ward peristalsis. These downward movements 
occur at intervals of about fifteen seconds. 

The tight closure of the ileocecal valve alone 
prevents the contents of the cecum from being 
forced by these powerful anti-peristaltic waves 
backward into the small intestine. At intervals the 
anti-peristaltic waves cease momentarily, while the 
ileocecal valve relaxes, and small portions of material 
are passed into the cecum from the small intestine; 
then the anti-peristaltic waves again begin, churn- 
ing the liquid material, spreading it over the sur- 
face of the cecum and ascending colon, thus encour- 
aging absorption, while at the same time exerting 
a pumping action upon the venous and lymphatic 
vessels, so that the contents of the cecum are rapidly 
dried down to the proper consistency. 

It is very probable that the common practice of 
resisting the "call" of Nature for evacuation, may 
have produced abnormal conditions of the colon, 



THE PHYSIOLOGY OF THE COLON 31 

by which its normal functions are obscured to a very 
considerable degree. The theory of anti-peristalsis, 
first suggested by O'Bierne, accords well with the 
facts of clinical experience, and may now be recog- 
nized as a fully established fact, especially since 
anti-peristalsis has been actually observed in man 
by Case on numerous occasions, in the X-ray de- 
partment of the Battle Creek Sanitarium. 

The Pelvic Colon 

The pelvic loop of the colon, which, with the 
iliac colon forms what was formerly known as the 
sigmoid flexure, constitutes the motive part of the 
mechanism by means of which the feces are dis- 
charged from the body. This loop of intestine, 
when empty, lies low down in the pelvis, the lower 
end of the loop where it joins the rectum being 
closed by a sharp fold. There may be a sphincter 
at this point, although not in a state of constant 
contraction. The loop fills from below as fecal 
matters gradually and slowly enter it from above. 
As it fills, the loop gradually rises, finally reaching a 
point at which the valve opens, so that the feces 
can enter the rectum. As the rectum walls become 
distended by the accumulation of feces, the defecat- 
ing center is stimulated; and powerful nerve im- 
pulses are sent out, which cause the pelvic loop to 
contract, thus compressing its contents just as one 
compresses the contents of a rubber bulb by squeez- 
ing it with the hand. The contraction of the pelvic 



32 COLON HYGIENE 

loop is normally so vigorous and complete that it is 
fully emptied of its contents. The contraction of 
the descending colon at the same time is normally 
sufficiently strong to carry the contents of the des- 
cending and iliac colon into and through the pelvic 
loop, so that the left half of the colon, from the 
splenic flexure to the anus is emptied in normal 
defecation. At the end of the contraction, the pelvic 
loop, or at least the mucous lining of the loop at its 
lower end, may be pushed down into the rectum 
like a piston, thus ensuring complete emptying of 
the rectum. The action of the pelvic colon thus 
resembles that of a bulb and piston combined, the 
upper part acting like a compressing bulb, while the 
lower part serves as a piston, thus forming a sur- 
prisingly effective mechanism for discharging the 
body wastes. 

Careful and long-continued observations of the 
time required for the passage of food through the 
different sections of the alimentary canal, have se- 
cured very definite and exact information upon this 
very important subject, on which are based the fig- 
ures given below. 

The following table shows, according to Rosen- 
heim, the time required for the food to reach the 
more important of the stations along the alimen- 
tary tube, reckoning from the time the food is 
eaten, since it is known that food begins to pass 
out of the pylorus very soon after the beginning 
of a meal: 



THE PHYSIOLOGY OF THE COLON 33 

The Digestive Time Table 

Cecum 4 hrs. 

Hepatic flexure 6 hrs. 

Splenic flexure 8 hrs. 

Iliac colon 9 hrs. 

Pelvic colon 10 hrs. 

Rectum 16 hrs. 

Discharge of residues 18 hrs. 

The X-ray shows that food often reaches the 
ileocecal valve within half an hour after it is taken 
into the mouth. It does not pass into the colon at 
once, nowever, but accumulates in the lowest coils 
of the ileum, which finally becomes distended to 
such a degree that segmentation is set up, and by 
this means the food is pushed forward into the 
cecum. 

The last of the food taken into the stomach 
does not reach the colon until the end of about nine 
hours from the time it is eaten. Thus, the entire 
meal should reach the pelvic colon, according to 
Rosenheim, at the end of about fourteen hours. 

The delay of six hours in the pelvic colon seems 
wholly unreasonable and unnecessary. If the food 
can pass from the splenic flexure to the pelvic colon 
in two hours (Rosenheim) it would seem that it 
ought to be able to traverse the short pelvic loop 
in the same length of time, or less. The processes of 
digestion and absorption of digested products is 
completed before the splenic flexure is reached. The 



34 COLON HYGIENE 

descending colon, iliac and pelvic colon, and the 
rectum, contain few absorbent vessels. The feces 
are ready for discharge from the body; what pos- 
sible benefit can result from their Longer retention? 
Putrefaction processes are actively at work produc- 
ing ptomaines and other toxins in quantity. By 
absorption, these may become a source of enormous 
and irreparable mischief. Why should not the un- 
usable food remnants, the wastes and microbes 
which constitute the fecal mass, be gotten rid of 
as soon as possible when prepared for exit? Is it 
not more than probable that the lower part of the 
human intestine, which is most subject to the in- 
fluence of voluntary interference, has been so long 
abused, discouraged and hindered that it has become 
abnormally slow and dilatory? 

Evacuation of the Colon 

The evacuation of the bowels is accomplished 
by means of seven distinct actions, three of which 
are voluntary and four automatic. Arranged in 
the order of natural sequence, the following are 
the several acts which together constitute normal 
bowel movement. 

1. Descent of the diaphragm and compression 
of the bowels, accomplished by taking a deep 
breath. 

2. Voluntary contraction of the abdominal 
muscles, increasing the compression. 



THE PHYSIOLOGY OF THE COLON 35 

3. Pressure of the thighs against the abdominal 
wall (natural position in moving the bowels is 
not the upright sitting position, but a crouching 
or squatting position universally employed by 
savages and in some pioneer rural communities). 

The result of these three voluntary efforts is to 
force a portion of the contents of the pelvic colon 
into the rectum, the distention of which gives rise 
to stimulation of the defecation center of the sym- 
pathetic nervous system by means of which the four 
automatic movements in defecation are brought into 
action, consisting of the following: 

4. Reflex contraction of the abdominal muscles, 
reinforcing the voluntary contraction. 

5. Contraction of the colon ; the descending and 
pelvic colons are chiefly active, though sometimes 
the whole colon contracts. 

6. Reflex relaxation of the anal sphincter, in 
obedience to the general law which holds through- 
out the entire digestive tube, by virtue of which 
a wave of contraction passing along any portion of 
the canal is immediately preceded by a wave of 
relaxation. 

7. Contraction of the levator ani, a structure 
which surrounds the rectum and contracts at the 
end of defecation for the purpose of forcing out 
the last remnants of fecal matter, so that the rec- 
tum may remain empty until another movement 
occurs. 



36 COLON HYGIENE 

There are really eight steps in the defecation 
process, if we include the preliminary filling of 
the pelvic colon with fecal matter. A disturbance 
of any one of these eight factors in the process 
of defecation may result in constipation. If the 
diaphragm contracts insufficiently because of weak- 
ness, tight lacing, adhesions or any other cause, or 
if the abdominal muscles are weak, as is generally 
the case among civilized people, and if the position 
assumed in evacuating the bowels is such that the 
abdominal walls are not compressed by the thighs, 
the result may be that the rectum is not filled suffi- 
ciently to stimulate the defecation center, and so 
the reflex necessary to set in operation the automatic 
movements which empty the bowel, will not be pro- 
duced. 

To be effective, the distention of the rectum 
must be complete, and must be accomplished 
quickly. If the rectum is allowed to fill grad- 
ually, stimulation may not occur. If, on the other 
hand, distention of the rectum, as evidenced by a 
desire to move the bowels, is not relieved by going 
to stool, the desire for movement gradually dis- 
appears through the loss of sensibility of the rec- 
tal nerves, and the reflex is lost. The nerves which 
preside over reflex activities are easily exhausted 
by continued stimulation. Human physiology af- 
fords many examples of this principle. 



The Ileocecal Valve and Its 
Function 

This is an extremely interesting and important 
anatomical structure, which, though known to 
science for three hundred and fifty years, has re- 
ceived almost no attention until very recently. The 
ileocecal valve was discovered by Servius in 1563, 
A. D. It has been described by numerous anatomists, 
but was until recently regarded rather as an ana- 
tomical curiosity with no very important function. 

The ileocecal valve consists of two parts — a 
sphincter muscle and a two-lipped check valve. 
The sphincter is formed by a thickening of 
the circular muscular fibres of the small intestine 
at its junction with the colon. The check valve is 
formed by an invagination of the small intestine 
into the colon. Something of an idea of the struc- 
ture of the valve may be formed from the illustra- 
tion opposite page 142. 

Action of the Ileocecal Sphincter 

*" Recent observations of Cannon have clearly 
demonstrated that the ileocecal sphincter acts in 
a manner very similar to the pylorus, retaining the 
foodstuffs in the small intestine until the digestive 

*The paragraphs in quotation marks are extracts from a paper 
by the author entitled, "Incompetency of the Ileocecal valve." 

37 



38 COLON HYGIENE 

work of the mid-gut is complete and the digested 
foodstuffs have been absorbed. 

"Within the last few years Holzknecht, 
Schwartz, Groedel, Case, and numerous other 
roentgenologists have clearly demonstrated the 
functional activity of the ileocecal valve in control- 
ling the movements of foodstuffs from the small 
intestine into the colon. These observations estab- 
lish the necessity of the ileocecal valve for the fol- 
lowing purposes: 

"1. To hold back the digesting material in the 
small intestine until the digested portion has been 
transformed by the several digestive juices, and ab- 
sorbed. 

"2. To pass the mixture of unusable food resi- 
dues, mucous, bile, and other excretions from the 
small intestine into the colon in small successive 
doses, so as to give the colon, the chief function of 
which is the absorption of water and the discharge 
of unusable food residues and excreta, an opportun- 
ity to deal with the successive portions of material 
brought to it without being over-loaded. 

"3. To prevent a reflux of material from the 
colon into the small intestine, which is accomplished 
by co-operation of the muscular sphincter of the 
proximal side, and the mechanical action of the 
membranous folds on the distal side of the ileocolic 
junction. The importance of this function of the 
ileocecal valve is greatly emphasized by the demon- 
stration, by Cannon, Schwartz, Case, and others, of 



THE ILEOCECAL VALVE AND ITS FUNCTION 39 

the existence of an anti-peristaltic action in the 
proximal half of the colon. Cannon gives a most 
graphic description of very powerful anti-peristaltic 
waves (as seen in the cat) beginning at about the 
middle of the transverse colon and passing rapidly 
backward along the colon to the cecum, compress- 
ing the liquid contents of the cecum so strongly as 
to cause a backward rush through the advancing 
ring of constriction. Case has confirmed these* ob- 
servations in the human subject in many cases." 



Normal Bowel Action 

There is perhaps no important bodily function 
so much neglected, and with such damaging results, 
as defecation or bowel movement. This function is 
too often looked upon as a humiliating act that 
must be secreted and avoided whenever possible, 
and that may properly be postponed to suit the 
exigencies of business or pleasure. The "call" of 
Nature for evacuation of the bowels is habitually 
ignored or resisted by children and adults alike, 
until it can no longer be suppressed, or until it 
disappears. 

This wrong attitude toward one of the most 
important functions of the body is in large part 
responsible for the almost universal existence of 
constipation among civilized people, and of wide- 
spread and most appalling evil consequences, as we 
shall make clear in a subsequent chapter. 

Ignorance of physiology, and especially of the 
physiology of digestion and nutrition, is doubtless 
the cause of this widespread evil. It is the duty of 
every physician and every trained nurse to do all 
possible toward the enlightenment of the chronically 
sick with whom they come in contact in relation to 
the absolute necessity for frequent and complete 
bowel action. 

This is a subject which is too commonly tabooed 
by a false modesty that is entirely out of place. 

40 



NORMAL BOWEL ACTION 41 

Mothers and school teachers especially should give 
the matter special consideration. They should make 
sure that each child under their supervision has 
formed and maintains correct and regular habits 
in relation to evacuation of the bowels. 

The Mechanism of Defecation 

Until very recent times the process by which 
the colon discharges its contents was one of the 
most obscure in physiology. The discovery of the 
X-ray and of a method of examination by which 
the contents of the stomach and intestines could be 
made to cast a shadow on the fluorescent screen 
or upon a photographic plate, has thrown a flood 
of light upon this extremely interesting and prac- 
tical question. 

As already remarked, the process of defecation 
involves seven distinct acts. Three of these are 
under voluntary control, the other four being con- 
trolled by a special center known as the "center 
of defecation, " located at the extreme lower end of 
the spinal cord. 

The act of defecation is called forth by a sensa- 
tion of fulness in the lower part of the colon. In 
a state of health we ordinarily perceive sensation 
only near the extremities of the alimentary canal. 
At the upper end of the food tube, guarding 
the entrance to the esophagus, there is located a 
reflex that controls the intake of food and liquids. 



42 COLON HYGIENE 

There are nerves in the mucous membrane at the 
back of the throat that, when stimulated by the con- 
tact of foods or liquids, give rise to the swallowing 
movement in which the esophagus opens and food 
or liquid present in the throat is drawn in by a 
strong suction movement. The act of swallowing is 
impossible without the contact of something that 
may be swallowed. 

At the other end of the food tube, within a few- 
inches of the anus — that is, at the upper part of 
the rectum — are found nerves that, when stimulated 
by the contact of fecal matters, give rise to a pe- 
culiar sensation recognized as a warning that the 
bowel contents should be discharged from the body. 

The "Call" 

Natural bowel movement is preceded by sensa- 
tions which clearly indicate the necessity for evacu- 
ation of the bowels. The mechanism of this instinct- 
ive notification of the necessity for giving atten- 
tion to the needs of the body is very interesting* 
We have already learned that the colon is sub- 
divided into four separate compartments and that 
the feces are dealt with by each of these in succes- 
sion. In the cecum the consistency of the feces is 
increased to such a degree that the mass can be 
handled by the muscular wall of the bowel. The 
ascending colon pushes the feces through the hepatic 
flexure into the transverse colon. In this horizon- 



NORMAL BOWEL ACTION 43 

tal portion of the canal the feces rest for a time 
for further extraction of water. From the trans- 
verse colon the feces are pushed up the incline 
to the splenic flexure, and through this narrow- 
gateway into the descending colon, along which, in 
the course of an hour or two, it finds its way to 
the capacious loop of the pelvic colon, through 
which it passes quickly to the lower end. Here its 
further progress is arrested by the tightly folded 
canal, just as a current of water through a rubber 
tube may be controlled by a sharp bend in the tube. 

The pelvic loop gradually fills, and in filling 
is raised until the bowel is unfolded and thus 
opened. Nov/, unless the feces have been so long 
retained that they have become hard and dry, the 
bowel contents are pushed on into the rectum. 

Up to this point the progress of the food material 
after leaving the mouth, during its passage through 
the long food canal, has been unattended by any 
sensation whatever. The process has been wholly 
automatic, and, though controlled in a way show- 
ing marvelous intelligence, wholly independent of 
the consciousness. But now there is felt an un- 
pleasant sense of weight in the region of the rectum. 
This sensation increases as the rectum becomes 
fuller, and there is a more or less urgent desire to 
evacuate the bowels. 

This is the "call" of Nature for bowel move- 
ment, evoked by the contact of the feces with the 
nerves of the rectum and distention of its walls. 



COLON HYGIENE 



The fuller the rectum becomes, the more pressing 
is the desire for evacuation. The "call" appears 
only when the feces have reached the rectum. 

It will now be easily seen how the "call" and 
the bowel movement may be directly influenced by 
numerous factors. Let us briefly notice some of the 
most important of these, which will be discussed 
more fully in a later chapter. 

If the food taken is insufficient in bulk, the 
pelvic loop will be only partly filled, and hence 
will not rise high enough to permit the feces to pass 
into the rectum, and hence there will be no "call" 
and no movement. It is evident, also, that if the 
amount of food taken is small, the pelvic loop may 
be so long a time in filling that the feces which first 
entered, will become so dry and compact that they 
may form a mechanical obstruction, and thus the 
onward movement necessary to reach the rectum 
will be prevented, even though the bowel may rise, 
and the gate which guards the entrance to the 
rectum may be open. In starvation, no "call" 
appears because there is nothing with which to fill 
the loop and open the rectal gate. 

Bodily movement has a certain amount of influ- 
ence upon the position of the loop and the entrance 
of feces into the rectum, especially deep breathing 
exercises, and bodily exercises which produce deep 
breathing. In deep breathing, the diaphragm is 
pushed down upon the abdominal viscera, compress- 
ing the colon as well as other parts against the ab- 



NORMAL BOWEL ACTION 4* 

dominal wall. By this means the feces in the loop 
may be pushed through the fold into the rectum, 
thus evoking a "call." 

The increased depth of breathing and the com- 
pression of the abdomen resulting from movement 
when one first awakens in the morning are no doubt 
the reasons why many persons experience a "call" 
almost immediately upon awakening after a full 
night's rest. During sleep the pelvic loop has been 
quietly filling and rising, but the pressure has not 
been quite sufficient to cause the feces to pass into 
the rectum. A push from the diaphragm and the 
abdominal muscles gives the little extra help needed 
and the "call" comes. 

By straining movements, such as accompany 
bowel evacuation, sufficient fecal matter may be 
pushed over into the rectum to create an effective 
"call," when not previously felt. Hence the import- 
ance of going regularly to stool even though no 
"call" is experienced. 

A cold morning bath helps in the same direction, 
both by causing deep respiratory movements, which 
increase the intra-abdominal pressure, and by caus- 
ing a reflex contraction of the colon. 

These facts are mentioned here in order to bring 
the explanation of the "call" within the range of 
common every-day experience, and to show its very 
important bearing upon the practical management 
of cases of constipation. 

The act of swallowing a glass of water, espec- 



46 COLON HYGIENE 

ially the drinking cf cold water, and above all other 
things the taking of food, by setting up peristaltic 
movements may produce a "call," provided there 
is at the time a quantity of feces in the pelvic loop. 
If the loop is empty, food taking, or anything else 
which sets up intestinal peristalsis will serve to 
help the feces along toward the pelvic colon, thus 
leading to a "call" a little later. The immediate 
effect of any such stimuli will of course depend 
upon the position of the fecal mass in the colon. 
If, for example, there is slight delay at the hepatic 
flexure, perhaps as the result of neglect of usual 
exercise or spending a day in bed, the use of meas- 
ures to promote intestinal action may seem to pro- 
duce no effect, whereas a bowel movement the next 
morning may be the result of the impulse given 
to the fecal mass by means of which the stagnation 
in the ascending colon was overcome. 

The Lost "Call" 

The "call" to bowel movement is like the call 
of the alarm clock set to awaken one in the morn- 
ing. If not responded to, it soon ceases to be 
heard. It is like the voice of conscience, which may 
be wholly stifled by continued disregard. This is 
only the operation of a general biologic law. A con- 
tinuous sensation which is ignored, by and by fades 
out of the consciousness. For example, the cloth- 
ing gives rise to no sensation unless adjusted in 



NORMAL BOWEL ACTION 47 

some unusual fashion, although in contact with 
almost the entire cutaneous surface. We are un- 
conscious of gloves or shoes, although our hands 
or feet may be tightly compressed. So, if the "call" 
evoked by the pressure of feces upon the nerves of 
the rectum is not responded to, after the lapse of a 
certain time the "call" is no longer heard. A mass 
of feces may lie in the rectum, but it produces 
no sensation. The writer has many times found 
large fecal masses in the rectum of which the pa- 
tient was wholly unconscious, although in some 
instances there was evidence that they had been 
present in the lower bowel for days or even weeks. 
The first time a "call" is disregarded it will 
return again when additional fecal matter is pushed 
down from the pelvic colon by the stimulus of the 
next meal, or as the result of some other influence 
which excites intestinal action or increases intra- 
abdominal tension. After having been disregarded 
or resisted many times, however, the "call" becomes 
less and less distinct, and by and by ceases entirely. 
The rectal nerves have lost their normal sensibility. 
They do not respond to the irritation produced by 
the contact of fecal matters, but have acquired a 
tolerance for such contact, just as the nerves of 
taste may become accustomed to contact with hot 
spices, so that they no longer cause any disagreeable 
serc^tion, or the skin may cease to react to a mustard 
plaster, so that a stronger irritant, as croton oil or 
a hot iroit. must be required to produce a blister. 



48 COLON HYGIENE 

This condition of lost sensibility is one of the 
most common causes of constipation, and a condition 
which is sometimes very difficult to remove, although 
always conquerable by persevering effort, thanks 
to the great light thrown upon these cases by mod- 
ern medical research. 

To lose one's "call" is almost as bad as to lose a 
fortune; indeed such a loss has more than once led 
to loss of fortune, and to worse results. A "call" 
that has been lost must be most assiduously sought 
for until recovered, and put into efficient operation. 
The methods for accomplishing this will be de- 
scribed at length in a later chapter. 

Why Do the Bowels Move Periodically? 

There are two factors which are chiefly active 
in producing bowel movements in normal individ- 
uals. The first is the practice of taking food only 
at stated intervals, regular meal hours. The sec- 
ond is regularity in the hours of sleep and morning 
rising. The omission of a meal, or a change in 
the hours of meals or of sleep will at once change 
or destroy the rhythm of bowel movements. Ani- 
mals that eat continuously, as monkeys and barn- 
yard fowls, have bowel movement many times a day. 

The taking of food is the most active of all 
natural excitants of bowel action. When food is 
taken into the stomach, it produces powerful peris- 
taltic waves which traverse the whole length of the 



NORMAL BOWEL ACTION 49 

intestine and carry the intestinal contents forward 
at a rate several times faster than the ordinary rate 
of progression; the larger the meal, and the more it 
is relished, the more pronounced is this effect. This 
explains the almost universal experience that the 
bowels move most freely and regularly soon after 
the morning meal. 

On rising in the morning after a full night's 
sleep, so long a time has elapsed since the last bowel 
movement that the feces have accumulated in the 
pelvic loop and the descending colon, and it is only 
necessary that sufficient stimulus should be applied 
to cause feces to enter the rectum, and a "call" 
and bowel movement will follow. The act of ris- 
ing, sometimes the mere awakening and the accom- 
panying turning and stretching movements, are 
often sufficient to accomplish this. During sleep, 
the intestinal movements are slowed. The progress 
of the intestinal contents along the canal is at a 
much slower rate than during the waking hours. 
This is easily shown by X-ray observations after 
a bismuth meal. At the moment of awakening, 
all the bodily movements are quickened. The heart 
beats faster, the force of the breathing is increased, 
and the whole vital machine feels the impulse of 
quickened energies. If the pelvic colon has been 
slowly filling during the night, the various influences 
which are brought into play at the moment of 
awakening will be likely to cause the passage of a 
sufficient quantity of feces from the pelvic loop 



50 COLON HYGIENE 

into the colon to produce a "call" and an evacu- 
ation. 

Regularity of bowel movement is of the utmost 
importance. It is a function which should be assidu- 
ously cultivated. As we have seen, the periodicity 
of alvine evacuation is not the result of any 
mysterious influence, but is a product of forces 
which are largely in our own control and are easily 
understood. 



The Feces 

The composition of the colon contents, the feces, 
is very complicated and highly variable, depend- 
ing very largely upon the character of the food. 
The bowel discharges of the nursing infant consist 
of fragments of undigested curds, fat, bile and a 
small amount of mucus. The odor of a healthy 
infant's stool is slightly acid, and yellowish in color. 
The stool of an adult who subsists upon an ordi- 
nary mixed diet contains a considerable amount of 
food residues, seeds and skins of fruit, cellulose 
from vegetables, and such whole-grain cereals as 
oat-meal and cracked wheat, and also contains one 
or two per cent of starch, about the same amount 
of fat, and three or four per cent of protein. Sugar 
is not present. The color is usually dark brown, 
often black, and the odor putrid. The form varies 
to a marked degree. 

The stools of a person who subsists on a nat- 
ural non-flesh diet closely resemble those of a healthy 
infant. The odor is not putrid, but may be slightly 
sour. 

Strassburger has shown that about half the 
solids of fecal matter is made up of bacteria. 
When the stools are putrid it is because of the domi- 
nance of the special bacteria which give rise to putre- 
faction. In sour smelling stools, however, the bac- 
teria present are chiefly those of the sort which cause 

51 



52 COLON HYGIENE 

fermentation and give rise to acid. The sour odor is 
due to the presence of acetic acid, which is more or 
less volatile at low temperatures. Lactic acid is also 
present. As it is non-volatile, its presence is shown 
only by chemical tests, not by the odor. 

The general belief that the feces or stools con- 
sist chiefly of the unusable remains of foodstuffs is 
entirely erroneous. As a matter of fact, even under 
the most unfavorable conditions, the feces contain 
really very little food material. 

Composition of the Feces 

The chief constituents of the feces are as follows : 
Bile, remains of digestive juices, especially of the 
pancreatic juice, mucus, excretory substances thrown 
off by the intestinal mucous membrane, microbes 
and various poisons produced by microbes, such as 
indol, skatol, pyrrol, and numerous other poisons, 
together with some small amounts of the various 
food principles, and water. 

The composition of the stool varies greatly 
according as the diet contains much or little of 
vegetables. On a vegetable diet the feces contain 
much cellulose, and with the cellulose are increased 
quantities of undigested protein and starch. The 
amount of fat does not vary much, and sugar is 
never present. 



THE FECES 53 

Quantity 

The weight of feces varies very much with the 
diet, increasing with a vegetable diet, and diminish- 
ing with a diet composed chiefly of animal substances. 
Food which contains much cellulose passes through 
the intestine much more quickly than does animal 
food, and hence contains more water and undigested 
food principles. The total weight of the feces for 
twenty-four hours with a mixed diet is about five 
ounces, of which three-fourths is water. With a 
vegetable diet the weight is double, the proportion 
of solid matter being slightly greater. 

The Microbes of the Intestine 

The reaction of the feces is neutral or slightly 
acid on a vegetable diet, and strongly alkaline on a 
flesh or mixed diet. This difference in reaction is 
due to the difference in the flora or species of bac- 
teria which are present. Feces that are rich in 
protein, the result of a mixed or flesh diet, contain 
enormous quantities of putrefactive bacteria, which 
produce alkaline substances in decomposing the 
proteins — ammonia, ptomaines, and various toxins. 
When considerable quantities of starch are present, 
as with a vegetable diet, with very little protein, 
acid-forming bacteria are dominant, and hence the 
feces have an acid or neutral reaction. 

This difference in reaction is one of the most 
important of all the various characteristics of the 



54 COLON HYGIENE 

feces, since it suggests at once the general character 
of the flora, and thus points to the toxic or non- 
toxic character of the stool. 

Roger calls attention to more than one hundred 
and sixty different species of bacteria which have 
been found in the feces. Of these, more than one- 
third were found to possess pathogenic or disease- 
producing properties. Distaso points out more than 
twenty species of putrefactive bacteria which are 
found in the stools of flesh eaters, all of which pro- 
duce very highly toxic products. One of the most 
common and abundant of these is the Bacillus of 
Welch, which produces enormous quantities of 
offensive gas and highly active poisons. This 
microbe, as well as the other putrefactive organisms 
which are found in the feces, is found in an active 
growing condition in butcher's meat and fresh flesh 
foods of all sorts, as well as salted and dried fish. 
This is doubtless the chief source of the dangerous 
bacteria which carry on in the body the same putre- 
factive processes to which they give rise outside 
of the body. 

The number of these microbes in the feces is 
something prodigious. They often constitute from 
one-third to one-half the total weight of dried feces. 
Strassburger estimates the weight of the microbes 
produced in the intestines in a single day at not less 
than one-quarter of an ounce, and the number more 
than one hundred trillions, of which a large propor- 
tion may be poison-forming organisms. Only a small 



THE FECES 55 

share of the bacteria are found alive in the feces (one 
per cent, according to Strassburger), but all have 
been alive and have each produced its portion of 
poisonous substances in breaking up the protein upon 
which it feeds. 

The study of these bacteria is one of the most 
important fields of research at present before the 
bacteriologist, for it has been clearly shown that 
the condition -of the flora of the intestine is one of 
the most important of all factors in determining 
health or disease, long or short life. Of this subject 
we shall learn more in a subsequent chapter. 

Excretory Products 

Not the least important constituents of the feces 
are the waste products which they contain, a fact 
quite too often overlooked. The mucous membrane 
of the intestine, like the skin, is an excretory organ. 
Although the extent of the intestinal mucus cov- 
ering is only seven square feet, about one-third of 
that of the skin, there is reason for believing 
that its importance as an outlet is fully as great 
as that of the skin, and probably much greater. This 
fact has only recently been made known. By the 
researches of Roger and others, it has been shown 
that the mucous membrane removes from the body 
some of the most deadly poisons which are produced 
in our tissues, or which may be introduced from 
without. If, for example, a quarter of a grain of 



56 COLON HYGIENE 

morphia is injected underneath the skin of a person, 
a large part of the poison will be found in the 
stomach and intestine within a half hour. This ex- 
cretion of poisons appears in the light of these new 
researches to be one of the important offices of the 
stomach. 

Lime salts which are no longer needed in the body 
are excreted through the intestine. 

The bile poured into the intestine contains some 
of the most deadly poisons produced in the body. 
Bouchard found the bile to be six times as toxic as 
the urine. 

Examination of the Stools 

When a doctor is called to see a sick infant, he 
first of all inquires as to the bowel passages, and 
the experienced nurse or mother always preserves 
the infant's napkins to show to the doctor when he 
comes. If the bowel passages have the usual con- 
sistency and yellowish color and a slightly acid odor, 
the doctor knows that there is no serious disturb- 
ance of digestion; but if the stools are dark or 
brownish in color and have a foul or putrid odor, 
this fact alone is sufficient to show to the physician 
or experienced nurse that the infant is sick. Any 
physician who would omit to examine the stools of 
an infant when called in consultation, would be 
regarded either as ignorant or as quite remiss in his 
duty. 



THE FECES 57 

It is very strange indeed that until quite recently 
almost no attention has been given to the stools of 
adults, and even at the present time physicians quite 
rarely take the trouble to make anything like a 
thorough investigation of bowel passages. The doc- 
tor usually contents himself by inquiring if the 
bowels move regularly. When questioned concern- 
ing the character of their stools, most patients are 
unable to give any information. Something can be 
learned from the general appearance of the stools, 
but for really useful information it is necessary to 
submit a specimen to a thorough laboratory investi- 
gation at the hands of an expert in this particular 
line of research. 

It is not going too far to say that a thorough 
examination of the stools should be made in every 
case of chronic disease. This practice has already 
been instituted in a few medical institutions where 
a high degree of medical work is done, and the time 
cannot be far distant when such an examination will 
be a routine practice with all physicians who attempt 
to keep abreast with the advance of medical science. 



Influences Which Excite Move- 
ments of the Colon 

The food tube is controlled by two sets of nerves* 
One, the motor, excites contractions of the intes- 
tine, while the other opposes this action, causing 
cessation of movement and relaxation of the intes- 
tine. The motor nerves are derived from the brain 
and spinal cord; those of the second class, known as 
splanchnic nerves, from the sympathetic. 

A very remarkable and interesting fact relating 
to the action of these nerves should be mentioned 
here as an aid to a full understanding of their action. 
When the motor nerves of the intestine are stimu- 
lated, they cause powerful contraction of both the 
intestine and the abdominal walls, but relaxation of 
both the internal and external anal sphincters. 
When the sympathetic or splanchnic nerves of the 
intestine are stimulated, they cause relaxation of 
the intestines, with cessation of movement, and at 
the same time strong contraction of the ileocecal 
sphincter. These two facts explain many important 
phenomena in relation to bowel movement and con- 
stipation. 

The relaxation of the anal sphincters when the 
colon and abdominal muscles contract, is necessary 
to facilitate the discharge of feces from the bowels. 
This fact wholly agrees with the interesting obser- 

58 



INFLUENCES WHICH EXCITE MOVEMENTS 59 

vations of Bayliss and Starling, that mechanical 
excitation of the intestine causes contraction at and 
above the point of irritation, and relaxation below, 
a most beneficent and wonderful adaptation of 
means to ends. 

One more important fact is especially worthy of 
note in this connection, viz., that the intestine is sup- 
plied with nerve ganglia of its own, located within 
its walls, between its two layers of muscles, so that 
it may act even when all cerebro-spinal and sympa- 
thetic nerves are cut in experiment or paralyzed in 
disease. A small bit of stomach or intestine removed 
from a living animal, when stimulated by electricity 
does not contract in continuous spasm as do ordinary 
muscles, but contracts rhythmically, as does the 
heart and other involuntary muscles. This is true, 
however, only when the nerve ganglia are removed 
with the muscle tissue. 

The Bile 

The bile is a normal stimulant to the colon, but 
for some curious reason does not act upon the small 
intestine. This seems unfortunate, for there is an 
increasing volume of evidence that in some of the 
most obstinate forms of constipation the chief cause 
of trouble is located in the small intestine. Possibly 
the biliary secretion of the degenerate modern civil- 
ized man has lost something of its original value as 
a laxative. The best proof of the laxative property 



60 COLON HYGIENE 

of the bile is found in the remarkable colon-stimu- 
lating properties of "bilen," an extract prepared 
from the bile, which when introduced into the rec- 
tum often produces active peristalsis within a few 
minutes, with vigorous bowel movement. 

A recent discovery has shown that the spleen also 
produces a substance which powerfully stimulates 
the intestinal peristalsis. This substance, however, 
acts upon both the small and the large intestine. 

Another remarkable substance, pituita, produced 
by a small gland in the brain, the pituitary body, is 
a most powerful stimulant to the entire intestinal 
tract. 

It seems hardly necessary to devote space to em- 
phasizing the importance of so guarding the interests 
of the liver and spleen as to receive constantly the 
full benefit of the powerful aid these organs are 
capable of giving to the muscular movements of the 
alimentary canal. 

. The intestine has two special senses, the muscular 
sense, which it possesses in a very high degree, and 
a fine tactile sense located in its mucous lining. 
The muscular sense is excited by distension of the 
intestine, which causes tension of its muscular walls. 

The Influence of Bulk 

In operations upon the stomach and intestines, 
the influence of mechanical stimulation is often seen. 
Slight pressure upon the wall of the stomach or of 



INFLUENCES WHICH EXCITE MOVEMENTS 61 

the intestine is sufficient to set up a contraction 
which follows in a few seconds. Contraction of 
the intestine, as shown by Bayliss and Starling, is 
accompanied by dilatation of the intestine lower 
down, so that room may be made for the material 
that is being pushed along. Contact of the food 
with the interior of the intestine produces like ef- 
fects. The greater the bulk of the food, the greater 
the effect. As shown by Cannon, segmentation, a 
most effective means of food propulsion, becomes 
really active only when the bowel is distended. 

All foods which are completely digested and ab- 
sorbed by the intestine, leaving little or no residue, 
discourage peristalsis. This is the reason why rice, 
boiled milk, and fine flour bread have become gener- 
ally known as constipating foods. These foods are 
not actively constipating; they simply do not leave 
sufficient indigestible residue to afford the necessary 
mechanical stimulation of the intestine. 

In general, all animal foods encourage consti- 
pation, for the reason that they are completely 
soluble in the digestive fluids. Hair, feathers and 
bones are almost the only animal tissues not capable 
of complete solution in the digestive juices. It is 
in part for this reason that carnivorous animals usu- 
ally eat bones with the flesh on which they feed ; 
the bones are of course necessary also for the lime 
which they contain, and which is almost wholly 
lacking in the soft tissues of animals. Most carniv- 
orous animals also eat more or less vegetable food. 



62 COLON HYGIENE 

Cats and dogs often nibble grass, and special weeds, 
of which they appear to be extremely fond. Fowls 
swallow feathers and sand. Horses sicken when 
fed on corn alone. They must have a liberal supply 
of coarser material. A Maine ship captain saved a 
cargo of mules, when the supply of hay was swept 
overboard, by feeding them shavings made by the 
ship carpenters. A number of horses in the cargo 
refused to eat the shavings and died. In England, 
when the price of grain is high, the farmers feed 
their stock on treacle, which is exceedingly cheap, 
combined with wood sawdust, and with good results. 
The animals readily fatten on this diet, and remain 
in good health. 

Most primitive people recognize the need of bulk 
to maintain healthy action of the alimentary canal. 
The Japanese and Chinese make large use of 
various seaweeds. One of these under the name of 
agar-agar has come to be well known in this country. 

Agar-agar is prepared from a sea-weed that grows 
on the coast of Japan and Ceylon. It is sometimes 
known in commerce as Ceylon moss. It is also 
known as Japanese isinglass or vegetable gelatine, 
It does not, however, have the composition of gela- 
tine. Its composition is practically identical with 
cellulose. It is almost wholly indigestible in the 
human alimentary canal. The commercial product 
is prepared by cooking the seaweed with much 
water in large kettles, then cooling the solution, and 
passing it through colanders by which it is formed 



INFLUENCES WHICH EXCITE MOVEMENTS 63 

into long strings. These are dried in the sun, and 
then bleached in the sun and dew for several weeks. 
This material is brought to the United States in 
large bales. In its commercial form, as it is obtain- 
able at many drug stores, agar-agar is hardly fit to 
be placed in the stomach. It needs to be thoroughly 
washed and disinfected by peroxide of hydrogen or 
some other efficient means. It is also very tough and 
inedible. 

Mr. George Kennan, the celebrated Siberian 
traveler, stated to the writer that the Eskimos eat 
half digested reindeer moss as a remedy for and pre- 
ventive of constipation. The moss is obtained by 
killing the reindeer at a certain time after feeding, 
removing the moss from the stomach, and submit- 
ting it to a very slight and simple preparation. 

The natives of Japan and China eat quantities 
of dried raw turnip, bamboo sprouts, lily flowers 
and roots and other vegetables with the rice which 
forms the staple food of these people. 

The Alaska Indians gather and dry a seaweed, 
which they eat at all seasons as a laxative. 

A missionary nurse working among the Alaska 
Indians, sent us a few years ago a sample of the 
seaweed which is used in its native state by these 
people to prevent the constipation which would nat- 
urally result from the nearly exclusive fish diet on 
which these Indians are compelled to subsist at 
certain seasons of the year. The sea-weed is simply 
gathered and dried in the sun and pressed into large 



64 COLON HYGIENE 

flat cakes between flat stones. The material thus 
prepared is very black in color but is crisp and not 
unpleasant in flavor. 

The Hopi Indian makes a good laxative food by 
grinding up in a stone mortar the whole nut of the 
pinon, including the shell. 

The Highland Scotchman escapes the constipa- 
tion which would otherwise result from his diet of 
buttermilk, oatmeal and potatoes, by eating his brose 
(oatmeal) in a half raw state. 

The wild Arab supplements his diet of camel's 
milk and dates with wheat ground in a stone mill, 
which supplies all the cellulose of the bran, with the 
addition of a certain amount of pulverized stone. 

The Orinoco Indians and the poor whites of the 
Tennessee Mountains combat constipation by eating 
considerable quantities of clay, as do horses and 
other animals when fed on a too concentrated diet. 

The desire for bulky green things, which afford 
much bulk with little nourishment, that almost 
every one experiences in the early spring time, when 
the oncoming heat reduces the bulk of the food by 
lessening the appetite, is an instinctive prompting 
which cannot be disregarded without injury. 

A western pioneer, who was shut up in the moun- 
tains of the Coast Range by an early fall of snow, 
and confined for three months with several com- 
panions and a number of mules with no food but 
corn meal, escaped without injury, although his 
associates all suffered extremely from scurvy, by fol- 



INFLUENCES WHICH EXCITE MOVEMENTS 65 

lowing the example of the mules, who dug tunnels 
in the fifteen-foot snow drifts and ate the grass hid- 
den underneath. 

A diet consisting largely of meat, eggs, milk, cane 
sugar and fine flour bread, leaves little or no residue 
to act as a stimulus to the intestinal muscles. The 
free use of greens and salads of lettuce, cabbage and 
other uncooked foods fresh from the garden is essen- 
tial to healthy intestinal activity. 

The Sugars 

Other elements of the food besides bulk, exert a 
marked influence upon the activity of the digestive 
organs. All the sugars stimulate intestinal activity. 
Roger thinks this action is confined to the small 
intestine, but in this he is in error, for every abdom- 
inal surgeon knows the remarkable laxative effects 
of an enema consisting of a half pint of molasses with 
an equal amount of hot water. 

Cane sugar is undesirable, however, because of 
its irritating effects. The sugars of fruits — levu- 
lose and dextrose — are wholesome and efficient. The 
malt sugar produced by the action of the saliva upon 
starch is of great service as a stimulant of gastric and 
intestinal activity. Many mothers know of the 
laxative effect of milk sugar added to the infant's 
food. Malt sugar is better, because free from germs, 
and more native to the body than the sugar of cow's 
milk. 



66 COLON HYGIENE 

Malt sugar, as shown by recent experiments, is 
absorbed in one-fourth the time required for milk 
sugar. 

Fruit and Vegetable Acids 

The acids of fruits and vegetables — citric, malic, 
and tartaric, — are excellent laxatives. This is, in 
part at least, the explanation of the good effects of 
an orange taken at night or before breakfast. All 
acid fruits are laxative. The tomato, a vegetable 
fruit, is a most excellent stimulant of intestinal 
action, chiefly through its citric acid. When possible, 
the tomato as well as other acid fruits should be 
eaten raw, to obtain the best effects. 

Lactic and acetic acids developed in the intes- 
tines by the growth of harmless acid-forming bac- 
teria, are a powerful stimulant of intestinal action. 
A. Schmidt of Halle, Germany, has demonstrated 
that these acids are the normal stimulants of the 
colon. When they are present in sufficient amount, 
bowel activity is normal. Putrefaction produces an 
alkaline condition in the colon which has a paralyz- 
ing effect upon the intestinal movements. Sour milk 
and buttermilk produce a decided laxative effect in 
many persons, especially in children. 

Fats 

Oils and fats stimulate intestinal action. Not 
only fats themselves, but the glycerine and soaps 



INFLUENCES WHICH EXCITE MOVEMENTS 67 

which are formed by the digestion or decomposition 
of fats in the intestine, are very active stimulants 
of intestinal movements. 

Mineral oil — white Russian paraffin oil — being 
indigestible and unabsorbable, is a very powerful 
stimulant of intestinal activity. It adds to the bulk 
of the food, lubricates the food canal, hinders the 
excessive absorption of water, and keeps the bowel 
contents moist. 

Gases 

The carbonic acid gas and other gases formed in 
the intestine by the fermentation of starch, cellulose, 
and other foodstuffs are powerful stimulants to the 
muscular activity of the bowel. When present in 
excess, gases cause spasm of the circular muscles of 
the intestine, with sharp colic pains. 

Eating 

The taking of food into the stomach is by far 
the most powerful of all the natural stimulants of 
the intestine. Very soon after food enters the mouth, 
peristaltic movements begin in the stomach, and 
quickly extend the whole length of the food canal. 
This is the reason for the desire to evacuate the 
bowels which most people experience soon after eat- 
ing breakfast. The peristaltic waves set up carry 
the feces down into the rectum, and this produces 
the sensation which indicates the necessity for evacu- 
ation. 



68 COLON HYGIENE 

It has been shown that even the smell of agree- 
able food is sufficient to cause increased intestinal 
activity. The act of swallowing also excites intes- 
tinal activity. 

X-ray examinations show that the intestinal con- 
tents move four times as fast during a meal as during 
the interval between meals. 

It is the opinion of the writer that bowel move- 
ments should occur after each of the principal meals 
of the day. This question is discussed further in a 
later chapter. 

Psychic Influences 

Pleasurable emotions and excitement have been 
known to produce intense activity of the intestines, 
and even diarrhoea, while depressing emotions have 
the opposite effect. This has been clearly demon- 
strated experimentally, in animals as well as clin- 
ically in human beings. 

Electricity 

This powerful agent may be applied in such a 
way as greatly to stimulate intestinal activity. The 
most effective method is the application of the sinu- 
soidal current to the rectum and abdominal muscles, 
or to the rectum and the central portion of the 
back. Another very effective method, perhaps the 
most efficient of all methods, is the application of a 



INFLUENCES WHICH EXCITE MOVEMENTS 69 

bi-polar electrode to the inner surface of the pelvic 
colon, which is the point of greatest delay in the 
majority of constipated persons. 

Mechanical Vibration 

Powerful mechanical impulses may be communi- 
cated to the intestines and the nerve ganglia which 
control them, by suitable apparatus. The writer 
has in numerous instances seen strong intestinal 
movements set up by this form of stimulation. 

Massage 

This is another valuable means of stimulating the 
bowel to increased activity. Kneading with the 
hands or with a suitable mechanical appliance has 
been shown to be capable of quickening the move- 
ments of the intestine, if applied with sufficient 
thoroughness. 

Stroking, or reflex titillation of the skin, stimu- 
lates the bowel in much the same way that tickling 
the soles of the feet may give rise to powerful con- 
tractions of the muscles of the legs. To be effective, 
massage intended to influence the intestinal move- 
ments must be given by an expert. 

Abdominal Compression 

This method acts upon the intestine by increasing 
the intra-abdominal pressure. It is most effective 



70 COLON HYGIENE 

when applied in cases in which the abdominal mus- 
cles are weak and relaxed. 

The compression may be made continuous by 
the application of a tight abdominal bandage; or 
intermittent pressure may be applied, if desired, by 
means of an inflated rubber bag. These measures 
will be explained more fully elsewhere. 

Exercise 

Bodily activity is another way of mechanically 
stimulating the intestine. Vigorous exercise sets the 
diaphragm and abdominal muscles at work in such 
a way that the intestines are, between the two, vig- 
orously kneaded and squeezed and thus stimulated 
to action. 

Every farmer knows the constipating effect of 
idleness upon his horses and cattle. Most observing 
persons have noted in their own experience the ad- 
vantage of taking a brisk walk before or after 
breakfast. 

The sedentary man or woman not only loses the 
immediate benefit which results from the increased 
activity of the diaphragm and abdominal muscles, 
but his abdominal muscles become permanently 
weakened, relaxed, lacking in tone, and incapable 
of supporting the intestines in their proper place, 
thus adding a number of other factors which con- 
tribute very materially to the lessening of intestinal 
activity. 



INFLUENCES WHICH EXCITE MOVEMENTS 71 

Posture 

A stooped or relaxed posture in sitting or standing 
tends strongly to induce constipation by weakening 
the abdomial muscles and causing congestion of the 
liver and all other abdominal organs. The viscera, 
over-filled with blood, and lacking the support of the 
abdominal muscles, become prolapsed. The colon 
falls with the rest; kinks are formed; the intestinal 
contents stagnate ; the bowel becomes distended ; the 
ileocecal valve becomes incompetent, infection trav- 
els up the small intestine, and a long list of ills 
result. The check valve action of the ileocecal valve 
is essential to the onward movement of the food 
residues, and therefore the crippling of this valve 
naturally leads to constipation. 

An erect posture secures proper exercise of the 
muscles of the trunk, correct breathing, normal cir- 
culation of blood in the viscera, and promotes in a 
high degree normal bowel movement. 

Hot and Cold Applications 

Cold applications, and even extremely hot appli- 
cations, act as powerful stimulants to the intestinal 
muscles. To be effective, the applications must be 
short and intense. The cold spinal and abdominal 
douche, and the cold douche to the feet and legs, 
are the most effective external procedures. 

The application of cold water to the bowel by 
means of the enema at a temperature of 75° to 40° 



72 COLON HYGIENE 

F. produces almost instant contraction of the bowel. 
The action is so intense that great pain may be 
produced, especially if a very low temperature is 
employed. 



Influences Which Lessen Intestinal 
Movements 

There are certain foods and other agents and 
influences that exercise a decided deterring influence 
upon intestinal movements, either directly, or in- 
directly through the suppression of the normal 
stimuli. 

Liquid Foods 

Such foods as soups, gruels, porridges, and purees 
contain so little solid matter that the bulk, consider- 
able though it may be when the food is eaten, is 
soon reduced to a very small volume. On this ac- 
count liquid foods are almost always constipating. 
The only exceptions are those liquid foods which 
contain much sugar, acids, or fats. 

Pasty cereals such as oatmeal mush, are 
decidedly constipating in their influence, because of 
their pasty consistency and the little mastication 
which : they receive. New bread, hot biscuits, 
/'noodles," and doughy foods of all sorts are like- 
wise objectionable. 

Concentrated Foods 

Foods which contain little or no waste or in- 
digestible material are so completely digested and 
absorbed that the bulk left in the intestine is in- 

73 



74 COLON HYGIENE 

sufficient to stimulate segmentation or peristalsis. In 
feeding the sick, the mistake is not infrequently made 
of feeding exclusively fluid or concentrated foods, 
with the idea that such foods tax the digestive 
organs least. In a sense this is true, but the impor- 
tance of maintaining proper bowel action is so great 
that this must be considered in the dietary, and with 
rare exceptions the patient will perfectly well toler- 
ate simple salads, stewed fruit of some sort, whole 
wheat preparations, especially wheat flakes, in which 
the whole grain is represented. 

The conventional "tea and toast" is about the 
worst diet that could be offered a sick person. The 
panadas, puddings, and "slops" of various sort are 
little better. 

The Properties of Fruit Juices 

Fruit juices of all sorts are, on the other hand, 
most suitable for almost all forms of sickness. They 
contain choice nutriment in a form needing no di- 
gestion, ready for immediate absorption and assimi- 
lation. 

Orange juice or freshly expressed juice of ap- 
ples, grapes, or other sweet or sub-acid fruit, is 
ideal nourishment for the sick. In the absence of 
these fruits, dried fruit, soaked long in water may 
furnish a very fair substitute. Canned fruit juices 
come next in value. To these rice, or some other 
cereal food, may be added in proper amount, with 
malt sugar in some form. 



INFLUENCES WHICH LESSEN MOVEMENTS 75 

Fasting 

In a state of absolute fasting the intestine is in 
a state of complete inactivity. The normal stimulus 
of food is lacking, and there is nothing to call forth 
the rhythmical activities which accompany normal 
digestion. In another chapter we shall discuss at 
some length the question of fasting as a curative 
means, a method which has almost assumed the 
character of a fad in certain sections. 

Pain 

Pain in almost any part of the body may arrest 
intestinal action by causing a reflex interference. 
Pain or inflammation in any part of the abdomen, 
especially such painful affections as rectal ulcer or 
fistula, inflamed hemorrhoids, chronic appendicitis, 
inflammation of the bladder, prostate, uterus, ovaries, 
and other pelvic organs, all give rise to inaction 
of the intestine, not only by inhibiting or preventing 
peristalsis, but also by causing obstruction through 
contraction of the ileocecal sphincter. The pain and 
irritation of an ulcer or fistula, or inflammed hemor- 
rhoids, may induce constipation by causing spasms of 
the anal muscle, and so preventing the normal re- 
laxation in the act of defecation. 

Miscellaneous Causes 

Depressing emotions, such as anger, fear, or des- 
pondency, all suppress the normal movements of the 



76 COLON HYGIENE 

intestine, and thus form a vicious circle which con- 
tinually aggravates both the malady and its cause. 

Heat lowers muscular tone, and hence checks the 
intestinal movements. This is well seen in the relief 
obtained by the application of a fomentation to the 
abdomen, or the administration of a hot bath or a 
hot enema in a case of intestinal colic or diarrhoea. 

Hot drinks, as well as hot baths, tend to slow 
intestinal movements, and the habitual use of warm 
enemas certainly aggravates the condition for which 
the treatment is given. 

Sweating, if very profuse, encourages intestinal 
inactivity by removing large quantities of water 
through the skin, and thus producing excessive dry- 
ness of the intestinal contents. 

Elevated body temperature, whether caused by 
fever or by a hot bath of some sort, slows the intes- 
tinal movements. 

Sleep and inactivity slow the intestinal movements 
by lessening the activity of the diaphragm and the 
abdominal muscles. The first voluntary movements 
made on awakening in the morning often start up 
peristalsis, and often provoke a desire for evacuation 
of the bowels. Persons who lead inactive lives almost 
always suffer from constipation, though often un- 
aware that this is the case, for reasons which we 
shall present later. 

Prolonged cold sitz baths cause intestinal in- 
activity by inducing a spasm of certain of the food 
gates, probably the ileocecal sphincter. This result 



INFLUENCES WHICH LESSEN MOVEMENTS 77 

occurs if the bath is continued for more than seven or 
eight minutes. When for any reason the use of the 
prolonged sitz bath becomes necessary, special pre- 
cautions in diet and otherwise must be taken to 
prevent producing this undesirable effect. 

A diet largely made up of meat necessarily favors 
intestinal inactivity, first because the complete diges- 
tion of the meat leaves too little residue to stimulate 
peristalsis, and second because an excess of protein 
encourages putrefactive processes in the intestine, 
which establish an alkaline condition of the intestinal 
contents, and thus prevent normal intestinal activity. 
The stools of flesh eaters usually have a very strong 
ammoniacal odor, and when tested by the chemist 
are found to be strongly alkaline. Alkalies paralyze 
the colon, while acids stimulate it. 



The Causes of Constipation 

The causes of a disease so universal in civilized 
communities must be very numerous to produce this 
condition in so great a number of people living 
under many different conditions, and with different 
habits of life. In general it may be said that the 
causes of constipation are abnormal habits or con- 
ditions of life, the result of what we call civilization. 
Savages rarely suffer from constipation, which is 
also true of the more primitive of so-called civilized 
nations. Chronic intestinal inactivity is much less 
frequent among country people than among those 
living in the city. It is manifestly a morbid condi- 
tion peculiar to a state of high civilization; and 
modern medical researches tend to show that this 
condition and its results may justly be looked upon 
as among the fundamental causes of the race de- 
generacy which is becoming every year more apparent 
in all highly civilized communities. 

We may therefore expect to find adults suffering 
from constipation much more than children, al- 
though this malady often begins early in life. 
Women are more subject than men to intestinal 
inactivity and all the terrible consequences which 
result from this condition. Westphalen asserts that 
four-fifths of all women suffer from constipation 
from their youth onward, a statement that is cor- 
roborated by Foges, the eminent specialist of Vienna, 

78 






THE CAUSES OF CONSTIPATION 79 

and that few experienced practitioners will deny. 
Adults have been longer exposed to the degenerative 
influences of civilized life than have children, and 
the life of civilized women is to a considerable 
degree more highly artificial and unnatural than 
that of men. 

Professor Virchow more than half a century ago 
called attention to the fact that post-mortem exam- 
inations show evidences of disease of the intestines 
in almost every case of many hundreds examined, 
irrespective of the cause of death. Indeed, he 
declared it to be almost impossible to find an adult 
person whose intestines did not show adhesions and 
other evidences of chronic disease. At that time 
the origin and significance of these inflammatory 
conditions was not understood. We now know that 
infections of the interior of the intestine, by causing 
inflammation of the intestinal walls, readily extend 
to the outside, giving rise to inflammatory changes 
and adhesions. In these adhesions, located in various 
parts of the intestine, but particularly at special 
points noted by Professor Virchow, and more re- 
cently by Dr. Arbuthnot Lane, we have both a 
consequence and a cause of constipation. 

The Rationale of Constipation 

To fully comprehend the influence of various 
habits and conditions in developing constipation, 
it is necessary to have in mind the mechanism of 



80 COLON HYGIENE 

defecation and the conditions essential to the normal 
colon action. The several acts by which the colon 
is emptied of its contents may be briefly summarized 
as follows : 

1. Contraction of the diaphragm — a deep 
breath. 

2. Contraction of the abdominal muscles. 

3. Pressure of the thighs against the abdomen 
as in the squatting position assumed by the savage. 

4. Reflex contraction of the abdominal muscles. 

5. Contraction of the colon. 

6. Relaxation of the anus. 

7. Contraction of the levator-ani muscles. 
Any influence which interferes with a single one 

of these seven steps in the normal process of defeca- 
tion may give rise to constipation, and when the 
disturbing influence is of such character as to inter- 
fere with several factors, the result is certain to be 
an extremely obstinate form of colon inactivity. 

The causes of constipation may become operative 
either before or during the action of defecation. 
In order that normal defecation should occur, it 
is necessary that fecal matters should reach the 
pelvic colon in condition to be expelled from the 
body, and that the pelvic colon should be free to 
rise out of the pelvis, so that it may discharge a 
part of its contents into the rectum; and it is then 
essential that there should be no interference with 
any of the several factors which enter into the 
normal act of defecation. 



THE CAUSES OF CONSTIPATION 81 

Among the causes that may operate to prevent 
the proper preparation of the bowel for the act 
of defecation through the accumulation of the bowel 
contents in the pelvic colon, are the following: 

1. Deficient bulk of intestinal contents. If 
the amount of the intestinal contents is too small 
to distend the pelvic colon, the bowel will not be 
stimulated to action. This condition naturally 
results during fasting, and may also result from 
the use of a concentrated diet. A diet largely made 
up of animal foods; that is, fish, flesh, fowl, eggs 
and milk, is always a concentrated diet, since these 
materials are almost entirely digested and absorbed, 
leaving no residue. On the other hand, vegetable 
foods, with a few exceptions, — such as the banana, 
potato, fine flour bread, and polished rice, — contain 
a considerable amount of cellulose, which in human 
beings is indigestible. 

2. A spastic or contracted condition of the bowel 
in the transverse, descending, or iliac colon may hold 
back the intestinal contents, preventing them from 
reaching the pelvic colon, and so may interfere with 
normal bowel action. This condition exists in 
nearly all persons suffering from colitis, the most 
common seat of which is the descending colon. 
The effect may be almost the same as that due to 
organic change, as from ulcer or adhesions. 

3. Adhesions, by interfering with the normal 
contraction movements of the colon, may seriously 
cripple its function. These adhesions may be the 



82 COLON HYGIENE 

result of peritonitis due to chronic infection of the 
mucous membrane extending through the wall of 
the bowel to its peritoneal surface. Such adhesions 
may occur between any part of the colon and the 
abdominal wall, but are most likely to occur in 
the lower part of the colon. Adhesions of this part 
of the colon are in the writer's experience very 
likely to be found present in cases of extremely 
obstinate constipation. 

4. Redundancy of the colon is another frequent 
cause of constipation. The overloaded colon is grad- 
ually stretched, until it may acquire nearly double 
its normal length. The redundant colon often be- 
comes folded upon itself, and adhesions form, giving 
rise to kinks which produce mechanical obstacles 
to the forward movement of the intestinal contents. 

5. Incompetency of the ileocecal valve, by pre- 
venting the forward movement of the intestinal 
contents, hinders the normal filling of the pelvic 
colon, and so leads to constipation. 

6. Ordinarily, the whole bowel is not emptied 
in the act of defecation. The length of the colon 
is such that the residue from two or more meals 
may be present in different parts of the intestine 
at the same time. For example, the supper residue 
may be passing into the cecum while the dinner 
residue occupies the transverse colon and the break- 
fast residue is in the pelvic colon ready to be dis- 
missed. 

The descending colon is normally found in an 



THE CAUSES OF CONSTIPATION 83 

empty state. When the intestinal contents are 
pushed from the transverse colon over into the de- 
scending colon, they are not long retained, as in other 
parts of the colon, but pass rapidly down to the 
pelvic colon, which seems to be intended by nature 
for a sort of discharging reservoir, in which the 
fecal matter accumulates until a sufficient degree 
of distention of the bowel has been induced to 
stimulate peristaltic action. 

A lack of this distending stimulus, which is es- 
sential to bowel activity, is a cause of constipation 
in a large number of persons whose pelvic colons 
have been over-distended. In such persons an 
extremely bulky diet is necessary to fill the pelvic 
colon to such a degree as to bring about the reflex 
movements which induce normal bowel action. 

In persons who are chronically constipated the 
descending colon is often constantly filled. The 
long contact of the poisonous fecal matters with 
the mucous membrane gives rise to infection. This 
is colitis. Colitis causes contraction of the bowel, 
thus becoming a new and most potent cause of 
constipation. The contraction produced by colitis 
not only obstructs the bowel, but also sets up anti- 
peristaltic movements, thus reversing the action of 
the bowel and carrying material back to the ascend- 
ing colon and cecum. Normally, the anti-peristaltic 
contractions start at the middle of the transverse 
colon and do not involve the lower half of the 
colon. But when colitis and spasm are present, 



84 COLON HYGIENE 

the reverse movement extends even to the pelvic 
colon. This fact, discovered by Case, explains the 
peculiarly irregular and erratic bowel movements 
characteristic of colitis. 

7. By compression of the waist, such as results 
from the wearing of corsets and tight dresses, the 
action of the diaphragm is greatly crippled. This 
may be one reason why women in general suffer 
from constipation more than do men. The feeble con- 
dition of the diaphragm and other breathing muscles, 
which is the natural result of neglect of exercise, 
produces a similar effect in both men and women. 

8. A feeble and relaxed condition of the ab- 
dominal muscles, the result of a sedentary life, 
and especially of a stooped and relaxed posture of 
the body in sitting or standing, will necessarily 
interfere with both voluntary and reflex contraction 
of these important muscles, which is an essential 
factor in normal defecation. When the colon has 
been long over-distended by neglect, and relaxed 
by the long-continued use of the warm enema, its 
power to contract is necessarily greatly diminished. 
This condition of the bowel not only prevents in- 
efficient normal defecation, but the efficiency of the 
bowel may be still further interfered with by 
adhesions and kinks. 

9. Hemorrhoids, fissures, ulcers, fistulae, and 
simple irritation of the mucous membrane in the 
anal region, may cause spasm or abnormal tightness 
of the anal muscle, so that the ordinary reflex is 



THE CAUSES OF CONSTIPATION 85 

insufficient to cause relaxation of the muscle, and 
it thus becomes a mechanical obstacle to bowel 
movement. 

10. The levator-ani muscle frequently becomes 
so weakened by continuous over-stretching, as the 
result of accumulation of hard fecal matters in the 
rectum, that it loses its power to contract. This 
condition may also be induced by proctitis, a common 
result of constipation. 

When the rectum walls are thus weakened and 
paralyzed, the rectum, instead of being always empty 
except during defecation, always contains more or 
less fecal matter, the constant contact of which with 
the mucous membrane produces loss of sensibility and 
chronic catarrh or proctitis, and often gives rise 
to hemorrhoids, anal ulcer, abscesses, fistula and 
local affections. 

It is thus apparent that in all cases of constipation 
there is a definite reason for intestinal inactivity. 
In every case of really serious constipation — that is, 
cases which are not relieved by regulation of diet — 
careful inquiry must be made for the purpose of 
ascertaining the exact conditions which are inter- 
fering with normal intestinal movement, including 
both the exciting and the predisposing causes of these 
conditions, which will be considered at length in 
succeeding pages. 

In discussing the causes of constipation, we will 
consider first of all the influence of habits of life 
upon the function of defecation, and will then notice 



COLON HYGIENE 



various morbid conditions in different parts of the 
alimentary canal, which may give rise to constipa- 
tion. 



Habits Which Give Rise to 
Constipation , 

In considering the habits of life common among 
civilized people which give rise to constipation, we 
shall not undertake to arrange the subject matter 
in the order of relative importance, but rather speak 
first of those which are most common. 

Hasty Eating 

Insufficient mastication is a fault peculiar to civ- 
ilized men. The savage, as well as the monkey 
and all lower animals that are provided with teeth 
for grinding food, masticates his food with the 
greatest thoroughness. The accompanying cut made 
from the lower jaw of a skull in the writer's pos- 
session, shows the teeth of an ancient mound builder, 
a Malkelkos Indian. The well-worn appearance of 
the teeth affords sufficient evidence of the thorough- 
ness with which they were used in grinding the nuts 
and cereal food which formed the dietary of these 
aborigines. 

Hasty eating leads to constipation in a variety 
of ways, but most directly, perhaps, by the rapid 
introduction into the intestine of a large amount of 
imperfectly masticated food material, which being 
slowly digested, undergoes putrefaction and other 
changes, by which the functions of every part of the 

87 



83 COLON HYGIENE 

digestive canal to the colon are more or less dis- 
turbed. As has been mentioned, the food is normally 
held back for three or four hours at the ileocecal 
valve, to permit the completion of intestinal digestion 
and absorption. When the food has been imperfect- 
ly chewed, it may be too long delayed at this point, 

As the result of the long delay in the small 
intestine, the food mass contains too little water 
when finally passed through into the colon, and 
is moved along with great difficulty, and by delay 
tends to dilatation of the colon. Under normal con- 
ditions the food does not remain in the body more 
than twenty-four hours, but under the conditions 
just described it may be retained for forty-eight 
hours or more, in the meantime undergoing putre- 
factive changes, which not only render the normal 
contents of the bowel alkaline, and thus deprive 
the bowel of a normal stimulus, but in time produce 
infection of the mucous membrane, which manifests 
itself ultimately as chronic colitis, or chronic ap- 
pendicitis. 

Hasty eating is a fault almost universal with 
the American people. The fifteen minutes' stop 
for refreshments at the lunch counter or eating 
house, and the general spirit of hurry which is 
everywhere manifest in our bustling communities, 
constantly encourage, almost enforce, wrong habits 
in eating. If time is limited, it would be far better 
to eat a smaller quantity and chew it well, than 
to swallow the whole amount half masticated. 



HABITS WHICH GIVE RISE TO CONSTIPATION 89 

Excessive Mastication 

Excessive chewing of the food, to which the term 
"bradyphagia" has been applied, has been charged 
with being a cause of constipation, and the charge 
may be true. A person who follows the recom- 
mendation made by some writers, to swallow nothing 
which cannot be reduced to liquid in the mouth, 
is sure to suffer from constipation as a consequence 
of insufficient bulk. Some have not only carried 
the practice of chewing to a great extreme, but have 
reduced the quantity and bulk of food to so low a 
limit that chronic constipation has been the natural 
result. Constipation is indeed so common a result 
that it has been by some commended as one of the ad- 
vantages of thorough mastication, a ''food economy" 
that should be cultivated. This is certainly an error, 
and a most dangerous one. We have been consulted 
by a number of persons who have found themselves 
suffering from severe constipation and resulting 
autointoxication, in consequence of so greatly re- 
ducing the amount of food eaten, and especially of 
the amount of insoluble residue, that there was too 
little left to evoke the necessary intestinal move- 
ments. The human alimentary canal is adapted 
to somewhat bulky and moderately coarse food- 
stuffs, and does not work well when such food 
materials are excluded from the bill of fare. Bulk 
is almost as necessary as nutriment. 

Food should be chewed sufficiently, that is, until 
the tongue no longer discovers coarse particles. 



90 COLON HYGIENE 

Insufficient Bulk 

The alimentary canal of man, while not so long 
in proportion to his size as that of the herbivorous 
animals, is much larger and longer than in animals 
which are intended to feed upon a flesh diet. The 
human intestine is approximately ten times the 
length of the body, that is, of the trunk, which is 
approximately half the height. The colon is sac- 
culated like the colon of herbivorous animals, and 
like that of the higher ape, indicating the adaptation 
of the intestines to bulky food. Fresh vegetables 
of all wholesome sorts are highly essential to give 
the food the necessary bulk required to stimulate 
the intestines to activity. A diet of bread and meat 
leaves almost no residue at all in the intestine. 

Fruits and fresh uncooked vegetables are used far 
less than they should be by the majority of people, 
especially by the poor. The Russian peasant keeps 
his bowels regular by the use of sauer-kraut, which 
serves him the same purpose as the products of the 
"silo" do the farmer's cattle. 

Vegetables, especially such vegetables as carrots, 
turnips, beets, parsnips, lettuce, cabbage and spinach, 
contain a large amount of cellulose, which is not 
readily digestible by the human digestive organs. 
This cellulose is highly important to make the 
nutritive elements of the food less concentrated 
and to furnish to the intestines the necessary stimulus 
to cause them to move the food and food residues 
along at a proper rate. 



HABITS V/HICH GIVE RISE TO CONSTIPATION 91 

Nearly all fruits and most vegetables, especially 
that curious vegetable-fruit, the tomato, contain 
organic acids, — citric, malic and tartaric. The free 
use of foods containing these acids is as wholesome 
for man as for other frugivorous animals. Their 
laxative effect is essential to maintain a healthy 
colon. 

Meat Eating 

Carnivorous animals have a short alimentary 
canal and a smooth colon. The movement of food 
stuffs along this short, smooth passage is rapid. 
This is necessary for the preservation of the life of 
the animal, as undigested remnants of meat long 
retained in the body necessarily undergo putrefactive 
changes with the production of ptomaines and 
poisons of a dangerous character. The digestion 
of meat leaves little residue, hence an animal that 
lives chiefly on meat has but little bulk to stimu- 
late the bowels to activity, a condition which favors 
the putrefaction of undigested remnants, and this 
by creating an alkaline condition of the intestines 
soon develops constipation. 

A diet of fine-flour bread and meat, with the 
usual concomitants of the ordinary bill of fare, 
would be an excellent prescription for the produc- 
tion of constipation. Within the last century there 
has been an enormous increase in the use of flesh 
foods in all civilized countries; and the use of 
modern milling proccesses has become almost uni- 



92 COLON HYGIENE 

versal. Fine flour bread and meat form a combi- 
nation that is productive of prodigious harm, not 
only in causing constipation, but also in depriving 
the bones of the lime salts which are essential for 
their development and maintenance. From the 
lack of lime salts comes decay of the teeth, and loss 
of the teeth leads to imperfect mastication of food. 
The increased consumption of flesh, and the sub- 
stitution of fine-flour bread for the wheatmeal of 
our ancestors, are two calamities, the evil results of 
which upon the health of the men and women of 
the present generation are incalculably great. 

Milk 

Within the last few years much evidence has 
accumulated to the effect that cow's milk is by 
no means the specially wholesome human nutriment 
that it was once supposed to be. Bunge, a great 
physiologist, and perhaps one of the world's great- 
est authorities on foods, goes so far, indeed, as to 
assert that many thousands of children are annually 
killed by feeding on cow's milk; and many persons 
have learned from their own observation that milk 
does not agree with them. Cow's milk is excel- 
lent food for calves, to which it is naturally adapted, 
but for many human adults it appears to behave 
almost as a poison. The probable cause is the very 
common inability to digest the casein of cow's milk. 
Personal observations in a very large number of 



HABITS WHICH GIVE RISE TO CONSTIPATION 93 

cases have convinced the writer that at least one- 
third, and probably more than one-half, of the 
persons suffering from chronic disease cannot use 
cow's milk freely without more or less serious 
injury. One of the prominent symptoms arising 
from the use of cow's milk is the production of a 
condition commonly known as "biliousness". The 
tongue becomes coated, there is a bad taste in the 
mouth, the breath is foul, the bowels are inactive, 
and an examination of the stools shows the pres- 
ence of considerable quantities of undigested casein 
undergoing putrefaction. 

The free use of milk is unknown among savages c 
The writer has no doubt that the extensive use of 
milk, under the mistaken notion that it is a spe- 
cially valuable food for adults as well as for infants, 
is one of the active causes of the steady increase of 
constipation amongst civilized people. Putrefaction 
of undigested casein in the colon produces an alka- 
line condition which paralyzes the bowel and 
encourages conditions by which the defecating mech- 
anism is in various ways more or less irreparably 
damaged. 

A Bland or Monotonous Diet 

Pawlow has shown the importance of taste as an 
element in digestion. According to his experiments, 
the activity of the stomach begins almost immedi- 
ately after food is taken into the mouth. The 
Intensity of the gastric activity depends upon the 



94 COLON HYGIENE 

degree of stimulation of the gustatory nerves. Cash 
has shown by experiments on dogs that even the 
smell of food produces peristaltic activity. If the 
food is not relished, the stomach does not produce 
"appetite juice", and the vigorous peristaltic move- 
ments that are essential for sound digestion, and that 
are equally necessary to stimulate movement of the 
intestinal contents all along the line, are not ini- 
tiated. It must be remembered, as has been shown 
in a previous chapter, that the taking of food, 
although it has for its primary object the introduc- 
tion of nutritive material into the body, is incident- 
ally necessary as a means of setting up the strong 
peristaltic waves that push forward the fecal matters 
that have accumulated in the colon, causing them 
to pass through the sphincter which guards the 
upper entrance of the rectum, and to set up the 
series of automatic movements by which this waste 
and unusable material may be removed from the 
body. 

In order, then, that these two prime purposes 
of eating — namely, the nourishment of the body, 
and the evacuation of poisonous material — should be 
efficiently accomplished, it is necessary that the food 
should be so inviting and stimulating to the senses 
which participate in the enjoyment of food that 
the digestive activity will be prompt and vigorous. 
A meal taken without relish and eaten as a mere 
matter of routine and duty does not accomplish 
this. A person who eats without appetite is always 



HABITS WHICH GIVE RISE TO CONSTIPATION 95 

constipated. Even if the bowels move regularly, the 
discharged materials should have been got rid of 
twenty-four or forty-eight hours before; there is 
a latent constipation, the evil results of which do 
not materially differ in the main from those of 
other forms of constipation, although likely to escape 
attention. The bill of fare should be so varied 
from day to day and from meal to meal, and the 
food should be of such a character, that each meal 
will be taken with keen relish. This is especially 
important for persons whose lives are sedentary, 
and who on this account are more likely to suffer 
from loss of appetite, and the constipation which 
is both a cause and a consequence of this difficulty. 

The Exclusive Use of Cooked Food 

While it is true that the cooking of food in 
general increases digestibility, experience in the 
feeding of both infants and adults has clearly shown 
that a diet consisting exclusively of cooked food is 
detrimental both to digestion and to general health, 
and may lead to the most serious results. It has, 
indeed, been shown that in children a cooked diet, 
such as sterilized milk, for example, may lead to the 
development of rickets and general mal-nutrition. 
Combe, one of the world's greatest authorities on 
infant feeding, asserts that the symptoms and injury 
from such a dietary make their appearance within 
two or three weeks. The writer's observations 



96 COLON HYGIENE 

have fully convinced him that adults as well as 
infants suffer from this cause. It has long been 
known that salt is not the exclusive cause of scurvy 
in sailors, as was once supposed ; it is rather the lack 
of certain elements — enzymes and vitamines found 
in raw foods, many of which are destroyed by the 
heat of cooking, and which are essential to good 
nutrition. 

Another objection to the exclusive use of a cooked 
diet has a special relation to the subject in hand — 
the fact that it renders the cellulose of the food too 
readily digestible by the intestinal bacteria, so that 
the amount remaining is insufficient to give to the 
intestine the needed stimulus to movement. 

The same objection also applies in relation to 
starch. Raw starch is .to a degree digestible in the 
intestine, but cooked starch is much more readily 
digestible. For good bowel action, it is necessary 
that a certain amount of undigestible starch should 
find its way into the colon. Cooked starch is 
quickly converted into sugar, and is completely 
absorbed in the small intestine. When no starch 
reaches the colon, the acid-forming bacteria which 
feed upon starch and convert it into lactic and other 
acids, are not able to grow; acids are not formed, 
the intestinal contents become alkaline, with the 
formation of ammonia and the putrefaction of pro- 
tein. This condition results in a semi-paralysis of 
the colon, so that the feces are too long retained, 
and putrefaction proceeds still farther. 



HABITS WHICH GIVE RISE TO CONSTIPATION 97 

Foods containing starch or cellulose should be 
taken every day, or preferably at every meal. Among 
foods of this kind to be specially recommended are 
green corn fresh from the garden (uncooked), 
lettuce, cabbage, and fresh fruits of all sorts, turnips 
of the best varieties, and even radishes, if care be 
taken to remove the acrid rind. Young carrots are 
also relished by some prepared raw. As a salad 
Cucumbers and raw tomatoes are excellent. 

These raw foods must be thoroughly chewed, 
as otherwise they may cause too long delay in the 
stomach or in the small intestine. The universal 
relish for fresh vegetables, and the intense craving 
for them, is an evidence of their value. These food 
stuffs, while supplying very little active nutriment, 
nevertheless furnish the body with quantities of cer- 
tain elements which modern research shows to be 
essential, while at the same time they supply neces- 
sary bulk and a sufficient amount of undigested 
carbohydrates to establish in the colon conditions 
essential for a normal activity. 

Hot Foods and Drinks 

Heat relaxes and paralyzes, while cold stimulates. 
For a muscle in a state of cramp or violent contrac- 
tion, the application of heat is the most efficient 
remedy. When food is taken into the stomach 
active muscular movements at once begin. As we 
have seen, these movements are essential, not only 



98 COLON HYGIENE 

for churning the food and passing it onward along 
the digestive tube, but also to move forward the 
contents of the colon to the sensitive point in the 
rectum, at which are set up the automatic actions 
by which the bowels are moved. Heat, whether 
taken into the stomach by food or drink, or applied 
externally, has the effect of weakening these move- 
ments. It does this by exciting the sympathetic 
nerves which hinder or inhibit the movements ot 
the stomach or intestine, and so check peristalsis. 
The practice of eating food as hot as it can be 
swallowed, and especially of taking hot drinks at 
meals, is unquestionably a very active cause of 
constipation. If the food is held in the mouth for 
a sufficient length of time to permit thorough 
mastication and the proper admixture of saliva, no 
harm will result from serving it hot when necessary, 
as it will be cooled in the mouth to body temperature 
before swallowing. 

Priessnitz, the sagacious peasant doctor of water 
cure fame, noted the unwholesome effects of hot 
foods more than a century ago. By experiments 
upon pigs he demonstrated that hot food produced 
an unhealthy state of the intestine. He accordingly- 
recommended his patients to take their food at the 
natural temperature of the air, and the thousands 
coming from every part of the civilized world who 
annually ate at his table in the little village of 
Graefenberg, hidden among the forests of Austrian 
Silesia, testified to his success in the treatment of 



HABITS WHICH GIVE RISE TO CONSTIPATION 99 

chronic constipation and numerous other ills which 
were at that time acknowledged incurable even by 
the best physicians. 

Hot foods and drinks produce a sensation of 
comfort in the stomach directly after they are swal- 
lowed. In certain forms of indigestion this effect of 
heat is particularly noticeable. In these cases, how- 
ever, temporary comfort is obtained only at the 
expense of the later serious disadvantages of the 
constipating effect of such a diet. 

A Meager or Low Diet 

Many persons suffer from constipation because 
they do not eat enough. They are in constant fear 
of overloading the stomach and bowels, and the 
consequence is that these organs lack sufficient work 
to stimulate them to proper activity. The writer 
has many times surprised such patients by the pre- 
scription of a meal two or three times as large as 
was being taken. The patient has usually found 
that he suffers no harm from his large meal, and is 
able to digest it without difficulty, and has also 
experienced a notable improvement in bowel action. 
The peristaltic waves which move the food along 
in the stomach and small intestine and the feces in 
the colon, are set up by reflex action excited by the 
food itself; that is, contact of the food with the 
mucous membrane of the stomach and intestine ex- 
cites certain nerves by which the muscles are stimu- 



100 



COLON HYGIENE 



lated to activity. This action may be likened to 
the ringing of a bell in response to the touch of an 
electric button, or the starting of an electric fan 
by the moving of a switch. When taken into the 
stomach, food by its contact with the mucous mem- 
brane sets in operation the food motor that operates 
in the upper part of the digestive canal to carry 
the food stuffs along from one part of the digestive 
tube to another and in the lower part to transport 
rubbish and refuse to the place of exit. 

The degree of this movement depends upon the 
amount of stimulation, while the amount of stimu- 
lation depends largely upon the bulk of food taken. 
This stimulating effect is produced not only in the 
stomach, but in the small intestine. 

It is evident, then, that for vigorous stimula- 
tion of the intestine, such as is needed to bring about 
the evacuation of the colon, a full meal must be 
more effective than a meagre one. This is one 
important reason why the taking of food at regular 
and not too frequent intervals is favorable to regular 
bowel action. A small amount of food taken at 
frequent intervals may not at any time set up a 
sufficient degree of stimulus to give the bowel the 
impulse required. 

People who "diet" do themselves great injury 
often by too great restriction of the bill of fare, 
both in quantity and variety of food. A food that 
the patient imagines to be constipating or otherwise 
harmful is generally found to have the expected 



HABITS WHICH GIVE RISE TO CONSTIPATION 101 

result. Thus, item after item the food is discarded, 
until the bill of fare is reduced to a few articles 
which are usually taken without relish and with 
more or less apprehension of injury. Such patients 
might far better pay no attention to diet whatever; 
they would run far less risk of injury by taking 
whatever the appetite craved. 

In this connection it should be noted, however, 
that in increasing the amount of the food intake, 
the increase should usually be in bulk rather than 
in food value. The added bulk should consist of 
such foodstuffs as lettuce, celery, turnips, tomatoes, 
greens, fresh fruits and other articles which give 
large bulk with little nourishment. 

Constipating Diets 

Nurses, and perhaps physicians also, sometimes 
unwittingly do their patients great harm by re- 
stricting the diet to bland or liquid foods, which 
are often taken without relish, and which on this 
account, as well as by lack of bulk, tend in the 
highest degree to promote intestinal inactivity and 
obstinate constipation. A diet like this naturally 
necessitates the use of artificial means for moving 
the bowels. Many a patient owes the beginning of 
his constipation to such a course of dieting during 
temporary illness. Milk, which has been so much 
relied upon as a sick-room diet, is particularly objec- 
tionable in a very large number of cases, for reasons 
which have already been given. Buttermilk is pre- 



102 COLON HYGIENE 

ferable, because of the lactic acid it contains, while 
its value is greatly increased by the addition of malt 
sugar or milk sugar, and wheatmeal porridge, or a 
porridge of corn meal or oatmeal made with an 
addition of wheat bran. Fruit juices are extremely 
useful. There are very few cases in which such 
fresh things as lettuce and scraped apple and other 
raw fruits may not be taken with great advantage 
as well as vegetable purees. The danger of the 
use of solid food in these cases is purely imaginary, 
if care is taken to exclude meat, fried foods, and 
indigestible combinations. Thorough chewing of 
the food is of course essential. 

The dietaries generally prescribed in certain forms 
of chronic disease, and considered to be essential, 
are often highly constipating. This is particularly 
true in the meat treatment for diabetes. Constipa- 
tion is nearly always found present in persons suf- 
fering from this malady. It will always be found, 
indeed, that constipation existed before the appear- 
ance of sugar in the urine. The writer has no doubt 
that chronic constipation is one of the most prolific 
causes of the rapid increase of diabetes in all civilized 
communities. The statistics gathered in the United 
States Census Bureau, show a death rate from this 
source nearly ten times as great as twenty years ago. 
As has been pointed out already, meat, which is 
usually the staple article prescribed for diabetic 
patients, leaves little residue, while at the same time 
promoting putrefaction in the colon, thus establish- 



HABITS WHICH GIVE RISE TO CONSTIPATION 1 03 

ing conditions which of necessity favor constipation. 
This difficulty may be entirely overcome by the 
free use of green vegetables, bran, and vegetable 
protein or pure gluten. 

In the dietetic treatment of hyper-acidity, and 
especially of ulcer of the stomach and the duodenum, 
the usual prescription is of such a character as to 
cause constipation, which in turn leads to intestinal 
toxemia and to a relapse later on. The withholding 
of bulk-forming food is by no means so essential in 
these cases as has been supposed; the essential thing 
is to avoid the stimulation of the gastric secretion by 
flesh foods and the extractives of meat that are found 
in bouillon, broths and meat extracts. These sub- 
stances powerfully stimulate the gastric secretion, 
and thus aggravate and perpetuate the ulceration. 
They also produce autointoxication, which encour- 
ages hyper-acidity and tends to the formation of 
ulcer. Carefully prepared vegetable purees may 
usually be given in these cases at least after the first 
few days, not only without injury, but even with 
much benefit, thus preventing the constipation which 
is certain to result from the bland, liquid diet. 

Fasting 

Fasting, which is sometimes prescribed as a reme- 
dial measure, necessarily leads to constipation, unless 
some preventive method is adopted. The use of the 
enema is not sufficient. Washing out of the colon 
can do nothing more than remove materials which 



104 COLON HYGIENE 

have been deposited in it from the small intestine; 
and in fasting, the small intestine as well as the 
stomach is in a state of complete inactivity. Bile, 
mucus and other secretions, as well as poisonous 
excretions from the blood, are accumulating from 
day to day, but there is no peristaltic movement to 
carry them onward, because no food is taken into 
the stomach. From these facts it is evident that 
absolute fasting, except when made necessary by 
some intestinal trouble or other equally imperative 
exigency, is rarely likely to prove beneficial. As a 
general measure for purifying the blood, removing 
uric acid, or producing tissue renovation, it is never 
required. The prodigious claims that have been 
made for fasting as a means of physical regeneration, 
are in the highest degree misleading. Not a few 
people have done themselves irreparable damage by 
a prolonged fast. The benefit derived from fasting, 
except when made necessary by a surgical operation, 
hemorrhage from the stomach or bowels or some 
other emergency/, is due to the withholding of pro- 
tein and fats, so that the body has an opportunity 
to clear itself of "cinders" and other waste and 
toxic matters derived from foods rich in protein, 
especially meat and eggs. All these benefits may 
be obtained by the exclusive use of juicy fruits for 
a limited period, or better still, by the use of fruit 
of some kind with bran and some green vegeta- 
ble, such as lettuce. By this means the food tube 
is supplied with the bulk necessary to maintain its 



HABITS WHICH GIVE RISE TO CONSTIPATION 105 

rhythmical action. The acids and sugars of fruits 
are active in the same direction, while at the same 
time furnishing the body with the necessary fuel 
to maintain animal heat, and support its activities, 
so that it is not compelled to feed upon itself, as 
certain animals when starving bite and tear their 
own flesh, and suck their own blood. 

The injury to which persons subject themselves 
by a long fast is similar to that resulting from a 
long fever; the conditions are really very similar. 
The appetite of the fasting person disappears on 
the third or fourth day, just as does that of the 
fever patient, and from the same cause, namely, the 
saturation of the tissues with toxins. In the case 
of a fasting person, the result of the absorption of 
poisons from the putrefying materials stored up in 
the inactive colon — foul breath and coated tongue 
—is evidence of this autointoxication, and not of 
a process of body purification. The foul breath and 
coated tongue are the result of a growth of bac- 
teria in the mouth and the intestines, which is en- 
couraged by the lowered vital resistance resulting 
from abstinence. The clearing of the tongue that 
occurs in many cases in from two to four weeks, is 
likewise comparable to the clearing of the tongue 
in typhoid fever, in about the same time, which re- 
sults from the development of immunity against the 
bacteria and bacterial poisons to which the body is 
exposed. In the case of the fasting person, clearing 
of the tongue may be induced by the taking of food. 



106 COLON HYGIENE 

The coated tongue does not occur in a "protein" 
fast, such as has been above described. 

Obesity 

In the treatment of obesity not due to disease 
of the glands of internal secretion, restriction of 
the quantity of food is essential; unless care is 
taken, this naturally leads to constipation — a very 
common result of dieting to reduce flesh. This 
effect of reduced diet is aggravated by the sweating 
which results from the hot baths administered, as 
well as from the vigorous exercise required. Con- 
stipation may be avoided in these cases by not di- 
minishing the bulk of the food intake while re- 
ducing its food value. Indeed, it is an advantage 
to increase the bulk. The free use of green vege- 
tables is especially indicated in obesity, as a means 
of preventing constipation. 

Condiments 

Mustard, pepper, pepper sauce, cayenne, capsi- 
cum, horseradish, and the whole list of hot, irritat- 
ing substances which are frequently added to food 
as seasoning, having no food value in themselves, 
are active causes of constipation. These substances 
produce, at first irritation, and later on catarrh of 
the stomach and intestines, leading to gastritis en- 
teritis, and colitis, and ultimately to degeneration 
of the gastric glands. The consequence is loss of 



HABITS WHICH GIVE RISE TO CONSTIPATION 107 

the normal reflex activity, to which the peristaltic 
movements are due. But the worst effects of con- 
diments are to be seen in the lower part of the small 
intestine and in the colon. Condiments being in- 
digestible, become more and more concentrated as 
the food substances with which they are eaten are 
absorbed, and hence their effects are seen in a very- 
pronounced degree at the extreme lower end of the 
small intestine, and in the colon where the food 
residues accumulate before passing on to the cecum 
through the ileocecal valve. When the irritating 
mass is pushed through the ileocecal valve, each 
successive portion falls at once upon the floor of 
the cecum, so that this small area, to which is at- 
tached the appendix, receives, so to speak, the con- 
centrated fire of these enemies of good digestion. 
The resulting irritation in the meantime results in 
infection, upon which follows colitis, and not in- 
frequently acute and chronic appendicitis, affec- 
tions which are both a consequence of chronic con- 
stipation. 

The concentrated residues of the food stuffs, 
including the indigestible particles of mustard, 
pepper, or other condiment taken with the food, 
brought in contact with the rectum cause chronic 
catarrh; hemorrhoids develop together with ulcers, 
fissures, and abscesses, followed by fistulae, and the 
way is prepared for tuberculosis and cancer. 

In India, especially in Ceylon, and also in Mex- 
ico, countries in which curries and hot, peppery 



108 COLON HYGIENE 

sauces are used, gastric catarrh, constipation and 
hemorrhoids are almost universal among those ad- 
dicted to the use of these pernicious food-poisons.. 

Irregular Meals 

When the meals are not taken regularly, the 
rhythmic peristaltic impulse by which the feces are 
pushed forward from the colon into the rectum is 
lacking. If for example, a person's habit is to 
move the bowels immediately after breakfast, and 
the breakfast is not taken, the bowels will not 
move, or if a movement occurs, it will be incom- 
plete; instead of complete emtying of the colon be- 
low the splenic flexure, which occurs in a normal 
movement of the bowels, only the pelvic loop 
will be emptied; and fecal matters remain in other 
sections of the colon. After the next meal, the 
stimulus may be sufficient to empty the colon com- 
pletely; but if the irregularity is frequently re- 
peated the normal rhythm of the bowels will be in- 
terrupted. The forward movement of food stuffs 
in the small intestine is continuous while digestion 
is going on; but the movement in the large intes- 
tine is more or less intermittent. If a meal is taken 
when the pelvic colon is loaded, the stimulus of 
the meal will cause the pelvic colon to contract 
and push forward a portion of its contents into the 
rectum. The feces in the rectum will excite the 
defecating center, and thus set up the automatic 






HABITS WHICH GIVE RISE TO CONSTIPATION 109 

action by which a movement of the bowel is 
effected. 

If a meal is taken at a time when the feces 
have not reached the pelvic colon, manifestly no 
movement of the bowels can occur, and a general 
contraction of the colon by which its contents are 
discharged does not take place. If, on the other 
hand, no meal is taken at a time when the pelvic 
colon is filled, the movement must be delayed until 
the next meal is taken, or perhaps until some un- 
usual straining movement or exercise serves to 
crowd out some of the fecal matter from the colon 
into the rectum. If the fecal matters retained in 
the pelvic colon become too dry to be readily 
moved by normal stimuli, a laxative or an enema 
becomes necessary. In many cases, this is the be- 
ginning of chronic constipation; a few repetitions 
may be sufficient to create a latent constipation in 
which the bowel movements are always twenty- 
four or forty-eight hours behind time. 

Since bowel movement depends so largely upon 
the stimulus derived from eating, it is evident that 
regularity of bowel movement depends upon regu- 
larity of eating. 

If a full meal cannot be taken, some fresh fruit, 
as an apple or two, or a couple of oranges, may 
serve the purpose to maintain the normal rhythm. 
When strong* stimulation of the colon is needed 
a bran biscuit may be added w T ith advantage, to- 
gether with a dose of paraffin. 




110 COLON HYGIENE 

Tea and Coffee 

Tea and coffee contain two substances the 
poisonous effects of which are well known, viz: 
caffein, a nerve poison practically identical with 
uric acid, and tannin, an astringent well known 
as one of the constituents of oak bark and many 
other vegetable substances. A cup of "good" 
coffee contains four grains of caffein and two of 
tannin. There is, in fact, nearly three times as 
much uric acid in a cup of coffee, in the form of 
caffein, as in an equal quantity of urine. The ef- 
fect of tannin upon animal tissues is well shown 
in the process of tanning, by which animal skins 
are converted into leather. Tannin is an active 
poison to the mucous membrane of the stomach 
and intestines; it not only interferes with the di- 
gestive processes, but it produces changes in the 
mucous membrane by which its power to respond 
to the delicate impressions made by the food is 
lessened. The result is diminished intestinal move- 
ment and constipation. 

Everyone is familar with the use of astringent 
or tannin-containing remedies in diarrhea. How- 
ever beneficial tannin may be in cases in which the 
bowels are abnormally active, certainly its effects 
are nothing but pernicious when habitually used. 
The average civilized man requires stimulation of 
his food tube rather than the use of substances 
which produce a paralyzing effect. 



HABITS WHICH GIVE RISE TO CONSTIPATION 1 1 ! 

Insufficient Fluid 

Most persons who suffer from constipation ha- 
bitually drink too little water. Women drink less 
than men. It is difficult to account for this scanty- 
use of a necessary of life, which costs little and is of 
such inestimable value to the body. Water is far 
more immediately necessary for the support of life 
than is food. A man may live six weeks or two 
months without tasting food in any form, but a 
few days at the most is the limit of human life 
without water. The consequence of a scanty use 
of water is abnormal dryness of the feces, which 
delays their passage through the lower colon, and 
often causes an actual stoppage in the pelvic colon 
or the rectum. 

Persons who sweat much, either as the result of 
hot weather, vigorous exercise, or hot baths, are 
likely to suffer from constipation, unless special 
care is taken to supply the body with water suffi- 
cient to make good the loss. The skin ordinarily 
throws off as perspiration an ounce and a half of 
water each hour, or more than a quart in twenty- 
four hours. By active exercise or sweating baths, 
this amount may be increased to thirty or forty 
ounces in an hour. The kidneys excrete two to 
three pints daily. It is evident, then, that care 
must be exercised to replace the water that is lost 
through the skin and kidneys. 

In diabetes there is a great loss of water through 



112 COLON HYGIENE 

the kidneys. This also must be made up by drink- 
ing. If these losses are not made good, the thirsty 
tissues will absorb as much water as possible from 
the feces, thus causing hardening and retention in 
the lower bowel. 

Scanty and highly colored urine is an evidence 
that the tissues are in need of water. Dryness of 
the skin often testifies to the same need. 

Water should be taken in proper quantity ir- 
respective of thirst. It may be made palatable by 
the addition of fresh fruit juices. 

For the average person a good plan is to take 
a couple of glasses of water on rising, and the same 
amount before retiring at night. A glassful should 
be taken half an hour before dinner and supper, 
and an equal amount two hours after eating. The 
free use of oranges or orange juice, and of other 
juicy fruits, serves the same purpose as water drink- 
ing, to the extent of the liquid which they supply. 

Persons suffering from obesity or diabetes are 
sometimes restricted in the drinking of water, with 
the result that constipation is produced, if this con- 
dition does not already exist. This should never 
be done. 

In all cases in which there is a tendency to drj'- 
ness of the stools, water should be taken in increased 
quantity. It is important in such cases also to di- 
minish the amount of salt eaten. The addition of 
salt to the food creates thirst for water to dissolve 



HABITS WHICH GIVE RISE TO CONSTIPATION 1 1 3 

it and to aid in its elimination through the skin 
and the kidneys. 

Children as well as adults need much more 
water than they are usually given. Meat eaters 
and those who use salt freely require a much larger 
amount of water than do those who adhere to a low 
protein dietary and who use little salt. 

Irregular Sleep 

The resumption of bodily activity on rising in 
the morning is one of the important means by 
which the bowels are made to act with regularity, 
by stimulating the colon to empty a portion of its 
contents into the rectum. When the hours of 
sleep are irregular, and especially when insufficient 
time is devoted to sleep, this physiological stimulus 
is lacking, and constipation may be one of the evil 
consequences resulting. Loss of sleep causes loss 
of tone in the intestinal muscles, as well as ot 
general muscular tone, and also lack of appetite, 
thus diminishing the normal stimuli to bowel move- 
ment, and so easily leading to constipation. Even 
when the bowels do not move soon after rising, 
the stimulus of rising after a good night's rest at 
least aids in the filling of the pelvic loop, which 
then only requires the stimulus of breakfast to 
cause a normal bowel action. Regularity of sleep 
is almost or quite as necessary for regular bowel 
movement as is regularity of meals. 



114 COLON HYGIENE 

Incorrect Breathing 

A child does not have to be taught to breathe. 
It breathes instinctively and hence correctly, for 
all instinctive movements are physiologically and 
hence correctly performed. But the breathing 

muscles are voluntary muscles, and hence may be 
controlled by the will. This fact permits modifi- 
cations of the act of breathing, which may or may 
not be physiological. Unfortunately, the condi- 
tions of civilized life are such as lead to serious 
perversions of the breathing process. Normally, 
when air is inhaled the whole chest is enlarged, but 
the chief movement is at the lower sides of the 
chest. This broadening of the chest at its lowest 
part stretches the diaphragm and thus gives it an 
opportunity to exert its greatest force. Its form be- 
ing arched, this is highly important. If its ends 
are held in place, the top of the arch can descend 
only a little, and while breathing is ineffective, the 
lungs being imperfectly expanded, the compression 
of the abdominal organs is equally inefficient. The 
diaphragm, it must be remembered, is a double act- 
ing pump. It creates a suction in the chest, while 
at the same time it produces pressure in the abdo- 
men. If its work is imperfectly done in one direc- 
tion, it fails equally in the other. 

The compressing movements produced by the 
diaphragm at each inspiration are, when efficient, 
of great service in assisting the movements of the 



HABITS WHICH GIVE RISE TO CONSTIPATION 1 1 5 

food along the alimentary tube. Acting upon the 
stomach, which lies just beneath it, the diaphragm 
churns the food and aids in pushing it along into 
the intestine. Acting upon the colon, which on the 
left side lies in contact with it, the diaphragm ren- 
ders great assistance in helping to push the food 
along toward the rectum. 

But it is especially in the act of defecation that 
the action of the diaphragm is important. The 
very first step in the process of unloading the bowel 
is in the sinking of the colon by a very deep 
breath. If the sides of the chest are compressed 
by belts or a corset, so that they cannot expand, 
the diaphragm cannot descend more than a short 
distance, and its action is inefficient. As a result, 
the fecal matters stored up in the descending and 
pelvic colon are not pushed onward to the rectum, 
and the bowel is only partially emptied. Thorough 
natural bowel movement is not possible without 
free and vigorous movement of the diaphragm. 

So, too, if the diaphragm is weak because of ha- 
bitual shallow breathing, the result of a bad posi- 
tion in sitting at work or study, the same result 
follows. A position which hampers the move- 
ments of the chest thus leads to constipation. 

The ordinary' house chair, especially the rock- 
ing chair and easy chairs in general, train the body 
in unhealthy attitudes and compel shallow breath- 
ing. When the chest is depressed, as when sitting 
in a hollow-backed chair, the abdominal muscles 



116 COLON HYGIENE - 

are relaxed, and the diaphragm cannot act well. 
There can be no compression of the abdominal 
viscera without a tense condition of the abdominal 
muscles. In most constipated persons these mus- 
cles are so relaxed and flabby that they render lit- 
tle service. The colon in such cases is compressed 
so feebly in defecation that it is never properly 
emptied except when the stools are made fluid by 
a laxative or by an enema. 

When, on the other hand, the chest is raised, as 
shown in the accompanying cut, the abdominal mus- 
cles are stretched, they are thus made tense, and the 
colon is kept under constant pressure, by which its 
contents are moved along at the proper rate; and 
when defecation occurs, these tense, well-developed 
muscles are ready to do their necessary part of the 
work 

Probably the majority of sedentary men and 
most civilizd women spend the greater part of 
their lives under conditions which induce imperfect 
breathing and lead to weakness of the abdominal 
muscles, and so to constipation. 

When we consider how universal among civilized 
women is the practice of compressing the waist 
by corsets or bands, we find a ready explanation of 
the fact that four-fifths of them suffer all their lives 
from constipation, while a large proportion suffer 
more or less from disorders peculiar to their sex 
which are by many supposed to be a necessary bur- 
den laid upon them, and an inevitable consequence 



HABITS WHICH GIVE RISE TO CONSTIPATION 1 1 7 

of femininity but are really due to causes which 
might be easily avoided. 

Deficient Exercise 

The relation between exercise and breathing and 
the necessity for vigorous and untrammeled action 
of the diaphragm have been already referred to in 
the preceding paragraphs. Exercise promotes 
bowel action, not only by aiding respiration and in- 
ducing vigorous movements of the diaphragm, but 
by calling into strong action the muscles of the 
abdomen, and by raising the general muscular tone 
of the body. 

The excellent effects that walking has upon 
bowel activity are well known. Riding is also of 
great advantage in the same way. These exer- 
cises, as well as many others, mechanically stimu- 
late the colon as well as all parts of the intes- 
tinal tract, by communicating to it a continued 
series of slight shocks, by which reflex movements 
are excited. The active play of children is as 
necessary to maintain proper bowel action as for 
muscular development. The movements of skip- 
ping, hopping, jumping, are especially useful, be- 
cause they induce sudden vigorous contractions of 
the abdominal muscles, and vigorous diaphragm 
movements by which the colon is compressed and 
stimulated. The folk dancing of the middle ages, 
which has been revived in recent years, is for the 



118 COLON HYGIENE 

above reasons to be highly commended as a health 
measure. It is important, however, to make a clear 
distinction between the varied and vigorous move- 
ments of the folk dance, in simple dress and under 
wholesome conditions, and the monotonous and re- 
strained movements of the social dance, in full 
dress and under conditions always physically, and 
not infrequently morally, unwholesome. 

Those whose occupations are such as to give 
them plenty of exercise are fortunate in being able 
to lead lives which in large measure conform to 
natural requirements. Such persons never need 
suffer from constipation if they eat proper food, 
drink an abundance of water — at least three to 
five pints daily — and take care to give the bowels 
an opportunity for movement after each meal, and 
promptly whenever there is a "call" for evacua- 
tion. 

Those who are compelled to lead sedentary lives, 
and especially women, whose lives are nearly always 
more or less sedentary in character, must take daily 
and regular exercise of a sort calculated to benefit 
the bowels if they would escape the evils of consti- 
pation and its secondary results. Some of the special 
exercises which have been shown by experience to 
be of greatest service in combating constipation 
will be described in a subsequent chapter. The ex- 
ercises of greatest value are those which strengthen 
the abdominal muscles. A spring abdominal sup- 
porter will usually render great service (page 298). 



HABITS WHICH GIVE RISE TO CONSTIPATION 1 19 

Resisting the "Call" 

The practice of resisting the "call" of Nature 
to discharge from the body accumulated wastes and 
rubbish is almost universal among civilized people, 
as the result of refinement of manners and modesty 
which lead to the concealment of certain animal 
functions as much as possible. That this is the 
result of what is commonly called false modesty 
cannot be denied, and yet there are few who would 
desire that this so-called false modesty should be 
altogether laid aside. It is important, however, 
that every person, children as well as adults, and 
at a very early age, should be fully instructed re- 
specting the evil results of resisting and thus thwart- 
ing one of the most important of the bodily func- 
tions. 

The "call" signifies that the pelvic colon is full 
of feces, and that a sufficient amount of fecal matter 
has been pushed down into the rectum to arouse the 
center of defecation and cause it to set in operation 
the automatic processes concerned in bowel move- 
ment. The colon is contracting, and there is a 
tendency for the anus to relax, which must be 
forcibly resisted to prevent immediate discharge of 
feces. The feces are normally stored in the pelvic 
colon, the portion which lies just above the rectum. 
So long as they remain here, there is no desire for 
movement, but when a portion of fecal matter 
has been pushed down into the rectum, the time 



120 COLON HYGIENE 

for evacuation has come, and the fact is indicated 
by a more or less urgent "call." When the feces 
are fluid, they reach the lowest part of the rectum 
at once, and the "call" is a very urgent one; but 
if they are of normal consistency, they are at first 
retained in the upper part of the rectum, and the 
"call" is less imperative, and may be suppressed by 
strong resistance. 

If, for any reason, the bowels are not permitted 
to move at once, the "call" usually disappears after 
a few minutes, and may not reappear until after 
the next meal or even the next day. In the mean- 
time, the feces which have entered the rectum lie 
there, and through the absorption of water by the 
intestines become each hour drier and harder, so that 
when the "call" comes again as the result of more 
feces being forced into the rectum and further dis- 
tention produced, evacuation may be difficult or im- 
possible without mechanical aid. 

It is possible, also, that the fecal matters which 
have been carried down to the lower part of the 
colon may be returned. It is not probable that this 
occurs to any great extent, however, for new install- 
ments of feces are continually coming down from the 
upper part of the intestine, and hence the feces 
simply accumulate, first in the pelvic colon, then 
in the iliac and ascending colon, and finally in the 
transverse colon, and even in the cecum and ascend- 
ing colon. 

Although the bowels may be permitted to move 



HABITS WHICH GIVE RISE TO CONSTIPATION 121 

when the next "call" occurs, the colon may not be 
fully emptied. The colon contents may by this time 
have become so dry and hard that the colon can- 
not be emptied by an ordinary effort. Thus there 
is left a residue in the pelvic and descending colon, 
which is likely to increase from day to day, or at 
least as often as there is failure promptly to answer 
the "call" to evacuation. 

As the necessary result of this gradual accumula- 
tion, the pelvic loop of colon becomes distended 
more and more. This fact accounts for the varia- 
tion in the size of this part of the colon which is 
far greater than in any other part. The late Dr. 
Byron Robinson of Chicago found in two hundred 
carefully measured pelvic colons a variation in 
length from five inches to thirty-three inches. The 
writer has several times encountered at the operat- 
ing table cases in which the pelvic colon was be- 
tween two and three feet in length. 

This stretching may extend to other parts, af- 
fecting chiefly, of course, the movable parts of the 
colon. The transverse colon often becomes loaded 
with delayed and dried feces, which in thin persons 
may be felt as hard irregular masses lying in the 
region of the umbilicus. 

The cecum is also often found greatly distended 
as the result of this hoarding of feces by resisting 
the "call". It is very probable that the fecal mat- 
ters are sometimes forced back into the transverse 
colon and the cecum by the strong contractions of 



122 COLON HYGIENE 

the colon in attempts at defecation. When a "call" 
is experienced, there are at once set up colon con- 
tractions which would expel the feces if permitted 
to do so ; but as the anus is held closed by voluntary 
contractions, the feces cannot be forced downward 
after the pelvic colon is filled, and the natural re- 
sult is a slipping back of fecal matters into the first 
half of the colon, some portion even reaching the 
cecum. 

By resisting and ignoring the kindly hint of Na- 
ture, that the body requires an opportunity to dis- 
pose of its poisonous wastes and refuse, thousands^ 
perhaps we should say millions, of men and women 
have brought upon themselves untold miseries, and 
have shortened their lives and have greatly impaired 
their efficiency and usefulness. Not a few persons 
are almost at once conscious of injury. A dull 
headache appears. There is less appetite than 
usual for the next meal. Sleep is less sound and re- 
freshing. The urine has a stronger odor, and the 
breath is offensive. These are simply the evidences 
of poisoning by absorption of toxins. The absorb- 
ent process which dries out and hardens the feces, 
carries with the water that is taken up and poured 
into the blood, quantities of poisons which it holds in 
solution. These poisons overwhelm the liver with 
unnecessary labor, tax the kidneys, irritate or stupe- 
fy the brain and nerves, and disturb every bodily 
function. 

The prompt evacuation of the bowels in response 






HABITS WHICH GIVE RISE TO CONSTIPATION 123 

to Nature's "call" is a sacred obligation which no 
person can neglect without serious injury. Ig- 
norance of this fact is one of the chief causes of 
the prevalence of constipation, a condition in which 
the body becomes a storehouse of the most disgust- 
ing and offensive material, which saturates the tis- 
sues with its horrible effluvium and its virulent 
poisons and taints the very springs of life. 

This fault is perhaps more common in America 
than in any other part of the world, especially in 
the cities. In English, German, French and Aus- 
trian cities places are abundantly provided, where 
well kept toilet conveniences are offered at a very 
small cost. One sees often in Vienna such notices 
as the following: "Urinal free. Seats, one 'heller' 
(a farthing or half cent)." The toilet arrange- 
ments at railway stations are sanitary and well 
cared for. There is room for great improvement 
in this particular in this country. Mothers should 
give more attention to the habits of their children 
in this respect. School teachers, at least in the pri- 
mary grades, should instruct their pupils concern- 
ing the importance of giving prompt heed to the 
"call" of the bowels for attention. Among savages 
this function receives much attention. A missionary 
physician tells of an Arab who declined to live in 
Aden because the city regulations required that the 
bowels should be evacuated only in certain places, 
as in all civilized communities, rather than any- 
where at any time the "call" demanded. 



124 COLON HYGIENE 

The worst results of these habits of postponing 
attention to the bowels to a convenient time, is the 
fact that the "call" after a time ceases. It is no 
longer made; or, if made, is so faint that it is not 
recognized. The continued pressure of the mass 
of hardened feces upon the nerves of the rectum 
destroys their sensibility, so that the "reflex" is no 
longer in operation. The defecatory center is not 
notified that evacuation is necessary, and the ac- 
cumulation of feces continues with no remonstrance. 
Quite a large proportion of chronic sufferers from 
constipation reach this condition before they really 
begin to give serious attention and study to the 
matter. 

There are thousands of persons who never ex- 
perience a desire for evacuation of the bowels ex- 
cept after taking a laxative. The cure of cases of 
this sort is one of the most difficult problems con- 
nected with this class of disorders, but with the 
thorough co-operation of the patient the normal 
"call" may be restored by patient application of the 
proper measures. No victim of this condition 
should rest contented until this has been accom- 
plished. For the body to be deaf to the needs of its 
sewage system, by which its most poisonous waste 
matters are removed, is a far more dangerous and 
serious condition than for it to be deprived of the 
sense of hearing. Fortunately this condition, se- 
rious as it is, may usually be relieved by the use of 
simple means. 



HABITS WHICH GIVE RISE TO CONSTIPATION 125 

Hurried Defecation 

The act of defecation normally occupies but a 
few seconds. The colon acts with so much cel- 
erity that when watched under the penetrating X- 
rays its movements can scarcely be followed by the 
eye. There is a vigorous surging which passes in 
waves from one end of the colon within a few 
seconds, and then the colon is at rest ; but it is easily 
seen that the contents have either disappeared or 
have been moved forward. After a normal move- 
ment, the colon is empty from the splenic flexure 
down, and there is seen to have been a forward 
movement of feces in other parts of the colon. 

There are, however, so many persons who are 
not quite normal, even though apparently healthy, 
that perfectly natural bowel movements are prob- 
ably the exception rather than the rule among civil- 
ized adults. It often happens, at least after the 
first portion of feces has been expelled, that a 
second or even a third installment is brought down, 
and a second or third action of the colon occurs. 
The pelvic loop of the colon has in most people 
been so much abused by resisting the "call" and so 
compelling an accumulation here, that it is often 
so much dilated or so much folded upon itself that 
two or even three efforts are necessary for its com- 
plete evacuation. To accomplish this requires a 
little patience, and sometimes a great deal of per- 
severing effort. The first partial movement empties 



126 COLON HYGIENE 

the rectum and the lower part of the distended pel- 
vic colon. By straining, that is, by strong contrac- 
tions of the diaphragm, aided perhaps by pressure 
with the hands upon the lower abdomen on the left 
side, an additional portion of feces may be forced 
down into the rectum. This excites the center of 
defecation just as touching the back of the throat 
excites the vomiting center, causes the colon to con- 
tract, the anus to open, and reinforcement of the 
contraction of the abdominal muscles with a second 
bowel movement results. In like manner, a third 
or even a fourth movement may be secured. 

But this requires time, perhaps five, ten or even 
fifteen or twenty minutes. The bustling or wor- 
ried business man, the hurried clerk, the student 
who has barely time to reach his school before roll 
call, the housekeeper who is perhaps superintend- 
ing some important culinary operation, these and 
a thousand other busy individuals believe that they 
have not time to devote to a function looked upon 
as grossly animal and repulsive, and so it is cut 
short at the earliest moment possible. 

Ignorance of the consequences does not, how- 
ever, prevent the evil effects which certainly follow 
such neglect. The feces left behind in the half- 
emptied pelvic colon become so dry and hard be- 
fore another opportunity for evacuation occurs 
that the difficulty is greater than before, and so a 
considerable quantity, often an increasing amount, 



HABITS WHICH GIVE RISE TO CONSTIPATION 127 

of feces is held back, and cumulative constipation 
is established. 

Undue haste in bowel movement is also en- 
couraged by unsuitable toilet arrangements. In 
many places, especially in country districts, the in- 
sufferable "privy" still exists, and is a most prolific 
source of misery. The use of such a place for 
evacuation of the bowels is at all times more or 
less inconvenient and offensive, and on this account 
is avoided as much as possible, leading to neglect 
of the "call", and when necessity compels the use 
of the offensive place, the visit is made as brief as 
possible. 

In cold weather, the danger of injury from ex- 
posure of the unprotected body to a low tempera- 
ture, sometimes even zero weather, is very great, 
especially in the case of feeble or delicate persons. 
Extreme cold also tends to prevent effective defeca- 
tion, by contracting the anal muscles so strongly 
as to negative the effect of the automatic reflex by 
which the outlet is normally opened. 

The toilet should be conveniently placed, and 
should be made as warm and comfortable as a 
bathroom. It should be kept in so neat and sani- 
tary a condition as to be in no way offensive. 

The time devoted to defecation should be suffi- 
cient for complete emptying of the descending and 
pelvic colon. All fullness and weight in this region, 
as well as the sense of fullness in the rectum, which 
commonly prompts to bowel movement, should 



128 



COLON HYGIENE 



disappear after defecation. If necessary to occupy 
the mind by glancing over a morning paper, this 
will do no harm provided that it is not allowed to 
interfere with the muscular efforts which may be 
necessary to force down into the rectum from the 
pelvic colon a sufficient amount of feces to induce 
an expulsive action of the bowels. 



Unnatural Posture in Defecation 

The natural position in defecation is squatting 
or crouching. All savages assume this attitude in 
moving the bowels. The reason for this, as has 
been fully explained in a preceding chapter, is that 
in the natural position the abdomen is compressed 
by the thighs, and thus the feces are forced into the 
rectum, and so the automatic process of bowel 
movement is set going. 

The ordinary water closet is so constructed that 
natural bowel movement is impossible in its use* 
By bending strongly forward, some compression of 
the thighs may be effected, but it is only in the 
squatting position that the pressure can be as great 
as is possible and often necessary. By placing a 
low platform in front of the closet so as* to raise 
the feet eight or ten inches, this objection may be 
very largely overcome. Some closets are now made 
with this idea in view, and are a great improvement 
over the old style. The same thing may be ac- 
complished by the use of a chamber. 



HABITS WHICH GIVE RISE TO CONSTIPATION 129 

Many surgeons have learned the importance of 
the squatting position to secure complete evacua- 
tion of the bowels and bladder, and forbid the use 
of the bed pan in any except the feeblest cases, re- 
quiring the patient to be supported as may be neces- 
sary while using the chamber. 

Although this matter is one of very great im- 
portance, it is more than likely that half a century 
will pass before manufacturers and plumbers, upon 
whom we are dependent for these necessary con- 
veniences, recognize to any appreciable extent the 
need of a change in closet construction. 

The Use of Tobacco 

Numerous laboratory experiments have shown that 
the use of tobacco in any form has a paralyzing 
effect upon the splanchnic nerves. Without the aid 
of the sympathetic nerves, normal, rhythmical 
bowel movements are impossible. The fact that 
some persons observe an apparently favorable in- 
fluence from smoking, is accepted as evidence that 
the effects of the weed are favorable to the bowels. 
These cases are exceptional. They happen to be 
cases in which there is an excessive action of the 
sympathetic nerves, so that the paralyzing influence 
of tobacco seems to be helpful. In general, and in 
the long run, however, the use of tobacco is highly 
injurious. Kreuznach, of Vienna, has recently 
shown that nicotine produces arteriosclerosis of the 



130 COLON HYGIENE 

splanchnic vessels. That is, it produces hardening 
and degeneracy of the vessels which supply the 
colon and other abdominal organs. This change 
in the blood vessels gives rise to general degeneracy 
and atony, and hence to constipation, by which it 
is always accompanied. 

Alcohol and Other Narcotic Drugs 

Alcoholic beverages of all sorts tend to produce 
constipation, by causing chronic and intestinal ca- 
tarrh, ulcer of stomach, and paralysis of the sym- 
pathetic nerves. 

Opium in all forms produces a specific effect in 
paralyzing the bowels. In former times in was 
customary to administer opium in sufficient doses 
in certain cases to cause complete inactivity of the 
bowels for a week or more. In such cases the con- 
stipation induced was often the beginning of 
chronic constipation of a most obstinate character. 

The very common use of opium for the relief of 
pain is a prolific cause of constipation, especially 
among women. The fact that a laxative drug is 
given to overcome the constipating tendency, does 
not prevent the evil that results, but only adds 
another. 

Bromides and sleep-producing or hypnotic drugs 
of all sort tend to produce constipation, although 
some of them are less harmful than opium. For- 
tunately, the use of these drugs may easily be dis- 



HABITS WHICH GIVE RISE TO CONSTIPATION 131 

pensed with when the resources of hydrotherapy 
and other physiologic means are made use of. 

The Use of Purgatives 

One of the best evidences of the universal prev- 
alence of constipation is afforded by the enormous 
use of laxative or purgative drugs. The quantity 
of this class of drugs used annually far exceeds 
that of any other class. Besides drugs proper, 
there is sold a prodigious quantity of laxative 
mineral waters. It would be difficult in the average 
community to find a household in which there is 
not kept on hand a supply of some favorite laxa- 
tive. The columns of the newspapers are filled 
with advertisements of drugs which act upon the 
bowels. Many housekeepers lay in supplies of 
bowel medicines as regularly as the stock of gro- 
ceries and other necessaries, and medical advice is 
sought no more in relation to one than the other. 
Laxative drugs have come to be regarded as staple 
commodities which stand, next to food and drink, 
as necessities. 

Unquestionably, an inestimable amount of in- 
jury is done by the use of these intestinal irritants, 
most of which are nostrums of the worst sort, pro- 
viding temporary relief only at the expense of 
permanent injury. 

It is not too much to say that all laxative drugs 



132 COLON HYGIENE 

are harmful. There is no such thing as a harm- 
less laxative medicine. 

Laxative drugs act in different ways, and some 
are more harmful than others. "Salines" impose 
heavy burdens upon the kidneys, besides irritating 
the bowels. When long used, they produce an 
obstinate intestinal catarrh, which aggravates the 
constipation. Almost without exception, laxative 
drugs increase the condition which they are sup- 
posed to cure. The most difficult cases to cure are 
those which have long made use of laxative drugs. 

Not the least of the damage done by laxatives 
is the injury to the stomach. The drug is ad- 
ministered by the mouth for the purpose of reliev- 
ing a difficulty at the other end of the digestive 
tract, than which it would seem nothing could be 
more irrational. In a large number of cases of 
constipation, the whole trouble is a loss of the rec- 
tal reflex. The feces accumulate in the rectum or 
the pelvic colon because of failure of the discharg- 
ing mechanism. What could be more really ab- 
surd and irrational than to irritate and worry the 
stomach and the whole twenty-five feet of small 
intestine, besides the cecum and the greater part 
of the colon, just for the purpose of exciting to 
action the last six inches of the intestinal tube, the 
rectum. 

As we shall see in the further study of this 
subject, constipation is not a disease, but only a 
symptom The morbid condition upon which the 



HABITS WHICH GIVE RISE TO CONSTIPATION 1 33 

symptom depends may be any one of a score or 
more of things, or several in combination. For the 
most part, these conditions, as we shall presently 
see, are such as are certain to be greatly aggravated 
by the use of laxatives or irritants of any sort. 

The use of laxatives as a routine measure, a 
practice which is almost universally in vogue with 
the profession as well as with the laity, is most illog- 
ical, and is productive of a prodigious amount of 
injury. 

The use of laxative drugs to cure constipation 
must be regarded as one of the most certain and 
prolific causes of this condition, and a person who 
has once formed the habit of using laxatives must 
as a rule continue the practice as long as he lives, 
unless he is so fortunate as to find some one wise 
enough to show him the way out of his troubles. 

The systematic use of purgatives for "cleansing 
the system," irrespective of the state of the bowels, 
is a very old custom still in vogue in various places. 
Nothing could more effectively operate to produce 
the most obstinate sort of constipation. An ex- 
cellent illustration of this baneful practice and its 
results came under the writer's observation a num- 
ber of years ago. A man past middle life sought 
relief from a constipation which he declared re- 
sponded to no drug in any dose. He had taken 
half a pound of "salts" without effect. The history 
which he gave revealed the cause of his unfortunate 
condition. The patient stated that when a child 



134 COLON HYGIENE 

at home ft was the practice of his mother to give 
to each child every Friday night a dose of "salts" 
as a sort of house-cleaning process to prepare the 
family for the proper observation of Sunday — 
whatever that may have meant. The result was 
that after a few years the weekly dose was quite 
insufficient, and daily doses of increased size be- 
came necessary. The dose increased from year to 
year, and new remedies were adopted as one after 
another ceased to be effective, until the whole list 
of laxatives had been exhausted. 

In another case, a patient who had taken at first 
small doses of licorice root and other simples, had 
become so constipated that even croton oil no longer 
produced laxative effects. The only remedy that 
remained at all efficient was a tablespoonful of un- 
ground mustard seed taken before breakfast. Many 
more lamentable examples of addiction to harm- 
ful and disease-producing laxatives might be cited, 
but such cases are familiar to every trained nurse as 
well as all physicians. 



Disorders of the Digestive Tube 
Associated with and Caus- 
ing Constipation 

The disorders of the alimentary canal, which 
give rise to constipation, are very numerous. Some 
are purely functional in character, others are or- 
ganic or structural affections. All are of a nature 
which cannot possibly be relieved by laxative drugs, 
at least, more than temporarily, and most are likely 
to be made worse by their use, a fact which shows 
the folly of depending upon them for the relief 
of this condition, which unfortunately is rarely 
treated in any other way. 

First let us study some of the functional dis- 
turbances of the digestive tract, which may give 
rise to inaction of the bowels. 

Lack of Appetite. — Lack of desire for food is a 
common result of constipation, and may also be a 
cause of this condition, when it is the result of 
some other cause, as lack of exercise, excessive 
heat, etc. With loss of appetite there is absence 
of relish for food, and hence a failure of the meal 
to awaken those lively peristaltic movements which 
are essential to propel forward in the colon the 
hardening masses of fecal matter which are stored 
up in its lower segments waiting to be discharged. 
Those who eat without appetite are always consti- 

135 



136 COLON HYGIENE 

pated, and while the lack of relish for the food 
encourages the constipation, the latter still further 
lessens the appetite, and so the difficulty continual- 
ly becomes more and more aggravated. 

In this condition there is usually found a coated 
tongue and foul breath, which point unmistakably 
to a state of low vital resistance and malnutrition. 
With the removal of these conditions by the appli- 
cation of the proper measures, the appetite will 
improve and the bowels, if not organically crip- 
pled, will assume their normal rhythm. 

Atony or weakness of the muscular walls of the 
colon itself, is no doubt sometimes a cause of very 
obstinate constipation. This condition sometimes 
appears to be hereditary. It occurs in families as 
a family characteristic. It is possible that in these 
cases the condition is only the result of improper 
care in infancy. No doubt a great number of 
cases of chronic dyspepsia and chronic constipation 
have their origin in the very earliest period of in- 
fancy. Prolonged indigestion in an infant may so 
damage its stomach and colon as to cripple these 
organs for life. The delicate structures of an in- 
fant's colon are easily stretched to such a degree 
as to be damaged permanently and to become a 
source of trouble during the whole after life. 
Cases of constipation which have existed for a life 
time are not infrequently encountered. Fortunately 
even these cases are often curable by the use of 
rational means. 



DISORDERS OF THE DIGESTIVE TUBE 137 

Atony of the colon is especially likely to be 
encountered in persons long past middle age; but 
it is not at all rare to meet cases, especially wo- 
men, in which the colon shows all the signs of 
senility at forty years, or even earlier. The age 
of the colon, like that of the arteries, is not to be 
reckoned in years, but is to be judged by the ex- 
isting degree of tissue change. A colon which 
has been continually distended with putrefying 
feces or poisonous gases during twenty years or so 
is a senile colon, no matter what the reputed age 
of the possessor. An eminent French physiologist 
has said, "A man is as old as his arteries;" and 
it might be said with almost equal truth, "A man 
is as old as his colon." 

In fever the colon as well as other parts of the 
intestine is in a state of semi-paralysis. The ele- 
vated temperature of the blood paralyzes the sym- 
pathetic nerves, and so interferes with rhythmical 
movements and causes constipation. Very hot 
weather and exposure to high artificial tempera- 
tures produce a like effect. 

In cases of extreme obesity, in which there are 
abnormal fat accumulations and fatty changes in 
various parts of the body, the intestine suffers with 
other tissues, even undergoing fatty changes which 
render it less effective in transporting its contents 
and resulting in stasis and constipation. 

Painful Affections of the Abdomen. — Pain in 
almost any part of the abdomen may cause consti- 



138 



COLON HYGIENE 



pation, through reflex arrest of peristaltic move- 
ment, and spasm of the ileocecal or pelvi-rectal 
valve. Chronic appendicitis is a common cause of 
this form of colon inactivity, sometimes called 
reflex constipation. The discovery of the fact that 
there is a sphincter at the ileocecal valve explains 
the relief from constipation, which often follows 
an operation for appendicitis. Painful affections 
of the uterus, ovaries and uterine appendages, in- 
flammation of the prostate gland, painful hemor- 
rhoids, rectal ulcer, and possibly ulcer of the 
stomach and duodenum may, through reflex dis- 
turbance of the sympathetic centers cause spasm of 
the ileocecal sphincter, and obstinate constipation. 
The most common cause of spasm of the ileocecal 
valve, however, is inflammation of the appendix, an 
affection which is even more common than is gener- 
ally supposed. The infection of the colon commonh 
known as colitis readily extends into the appendix, 
which often becomes adherent to the lower end of the 
small intestine and interferes with the action of the 
ileocecal valve, both by causing spasm of the ileo- 
cecal sphincter and by preventing proper closure of 
the lips of the valve, so as to prevent the reflux of 
fecal matters from the colon. Interference with 
the closure of the valve is also 'prevented by ad- 
hesions of the appendix to the cecum, a very common 
condition. Delay of the intestinal contents in the 
lower part of the small intestine, either by spasm of 
the valve or incompetency (failure to close), is one 




A Spastic Colon. Darkest Portion Shows Dila- 
tation — Arrows Indicate Spastic Condition 



DISORDERS OF THE DIGESTIVE TUBE 139 

of the most pernicious forms of constipation. The 
delay occurs at a point where putrefaction is most 
active and absorption is also greatest. Cases of this 
sort usually present very active symptoms of in- 
testinal toxemia. Such persons are often victims 
of attacks of violent headache. They show much 
indican in the urine, are likely to have high blood- 
pressure, and sooner or later develop chronic Bright's 
disease of the kidne^-s. 

Painful affections of the abdominal organs, such 
as chronic appendicitis, colitis, adhesions following 
an abdominal operation, pelvic or bladder disease, 
may cause constipation, not only by producing reflex 
spasm of the ileocecal valve, but by restraining the 
patient from making the necessary effort to expel 
the colon contents. Such efforts naturally increase 
the pain, and so are dreaded and avoided. In such 
cases the application of a hot fomentation over the 
seat of pain before ordering the effort to move the 
bowels will often render very great service. A 
hot sitz bath may be taken instead. A hot water bag 
placed against the abdomen may be found useful 
both by lessening pain and as a mechanical aid to 
defecation. 

Depressing Emotions. — Fear, disappointment, 
anger, or any depressing emotion, may, through 
the sympathetic nerves, cause reflex constipation, 
Prof. Anderson, an eminent Danish physiologist 
who has made an exhaustive study of the influence 
of the emotions, found that depressing emo- 



140 COLON HYGIENE 

tions powerfully excite the sympathetic. Some 
persons are unable to move their bowels be- 
cause they are in a state of fear that they cannot. 
All persons are more or less at the mercy of the 
sympathetic nervous system, but some much more 
than others. A curious example of the effect of 
mental influence is the case of a woman mentioned 
by Hertz whose bowels were obstinately constipated 
but who had a good movement of the bowels 
whenever she gave one of her children a dose of 
castor oil, although the oil produced no effect when 
she took it herself. 

Obstructions. — Probably half the cases of 
chronic constipation are really due to some form 
of obstruction at some point along the food canal. 
It matters little, apparently, where the obstruction 
is; the effect is delay, and this results in constipa- 
tion from absorption of water and the resulting ex- 
cessive dryness of the feces. 

Contracted Colon. — In cases of reflex spasm of 
the colon, or spasm due to colitis, the intestine can 
often be felt under the fingers, to which it gives 
the sensation of a rubber tube. When the contrac- 
tion is due to colitis, the intestine is not only hard 
and contracted but is also tender to pressure, some- 
times extremely so. In such cases there are likely 
to be present various reflex pains such as headache, 
or pains in the legs, which in women suggest 
ovarian inflammation or some other pelvic disease. 

This condition of the colon is most often found 



DISORDERS OF THE DIGESTIVE TUBE 14! 

on the left side, at the site of the iliac colon, some- 
times extending upward, and may occasionally be 
felt in the pelvic colon also. The cecum and the 
ascending colon are not infrequently affected, and 
more rarely the transverse colon, which may be 
felt as a hard round cord passing across the abdo- 
men just above or below the umbilicus. 

These spastic contractions are not permanent; 
they come and go, sometimes disappearing while 
under the examining finger; but they cause great 
delay in the progress of the feces along the bowel, 
and thus lead to excessive dryness and constipation. 

Organic or permanent contraction of the colon 
is a much more serious condition than simple spas- 
tic contraction, because usually incurable, except by 
surgery. It may be the result of peritonitis or of 
colitis followed by pericolitis and adhesions. 

Incompetency of the Ileocecal Valve 

One of the consequences of chronic constipation 
is incompetency of the ileocecal valve. By over- 
distention the intestine becomes so widely dilated 
that the lips of the valve no longer come in contact 
and so its check valve action is prevented, and the 
putrefying contents of the colon readily pass back- 
ward into the small intestine. The infection thus 
induced may travel backward the entire length of 
the small intestine, to the stomach, liver, gall-blad- 
der, pancreas and duodenum, giving rise to ulcer 



142 COLON HYGIENE 

of the stomach, duodenal ulcer, gall-stones, inflam- 
mation of the gall-bladder, infections of the liver 
and jaundice resulting from these conditions, and 
pancreatitis, a still more serious condition. It is 
probable also that the worst effects attributed to 
alimentary toxemia or intestinal intoxication are 
seen in cases in which through incompetency of the 
ileocecal valve, the putrefying materials of the 
colon find ready entrance to the small intestine, 
and are thus rapidly absorbed. 

When the ileocecal valve is incompetent, it is 
of course incompetent to gases as well as liquids. 
There is evidence that the valve sometimes becomes 
incompetent to gases while it still may be com- 
petent to liquids. Patients whose ileocecal valves 
are incompetent surfer from . great discomfort be- 
cause of inability to expel' gas from the intestine. 
When an expulsive effort is made gas passes in both 
directions, that is, out of the body and back up into 
the small intestine. 

There is reason to believe that the failure of 
short-circuiting 'operations either with or without 
removal of the colon or a part of it, is often due to 
loss of the function of the ileocecal valve, which is 
of course removed with the colon. Recent ad- 
vances in the department of surgery make it pos- 
sible to remedy this defect by constructing an ar- 
tificial ileocecal valve. 

In like manner incompetency of the ileocecal 
check valve interferes with the complete and proper 







O. a 



CQ 



> 



DISORDERS OF THE DIGESTIVE TUBE 143 

emptying of the colon and thus becomes a cause as 
well as a consequence of constipation. 

The worst evils resulting from incompetency 
of the ileocecal valve may be corrected in the ma- 
jority of cases by removing the cause, namely, re- 
lieving the constipation to which it is due. While 
in a majority of cases, this may be accomplished by 
the employment of the thoroughgoing measures 
suggested in this volume, a few cases remain in 
which an operation is required for breaking up 
adhesions of the pelvic colon and removing the 
other obstructions which have been the cause of 
the overloading and the distention of the cecum, 
which produced the incompetency of the valve. 
Fortunately such cases may be relieved by surgical 
operation, and it is even possible to repair the valve 
so as to enable it to resume its function. 

"Greedy Colon" 

Goodhard, Schmidt, and others hold that abnor- 
mal dryness of the feces may be produced by excess- 
ive digestion and absorption, leaving so little residue 
that the bulk of the intestinal contents is too small 
to stimulate peristaltic action. It is possible that 
cases of this sort may exist, but it seems more prob- 
able that the fault is a too concentrated diet or 
deficient gastric or intestinal secretion, at least in 
most of the cases in which this diagnosis has been 
made. It is much easier *,o see how the intestine can 



144 COLON HYGIENE 

fail to do its work completely than to understand 
a condition of excessive activity of digestion. 

Excessive Dryness of the Feces 

Persons who sweat profusely, even if their 
habits are active, often suffer from constipation, 
because of dryness of the stool. This condition may 
also result from sweating baths and from the 
drinking of an insufficient amount of fluid, as we 
have already seen. 

Excessive activity of the kidneys, as in diabetes 
mellitus or diabetes insipidus, may produce the same 
result, by depriving the feces of water. 

A deficiency of fat in the food leads to constipa- 
tion in like manner. The presence in the feces of 
a certain amount of unabsorbed fat is useful not 
only to prevent excessive dryness, but to prevent 
too great adhesiveness of the feces and thus to fa- 
cilitate movement along the colon. 

Contraction of the Ileocecal Valve 

Various causes, as we have already seen, may 
cause delay at the ileocecal valve, such as reflex 
spasm set up by pain in neighboring organs, and the 
irritation of condiments or imperfectly digested 
foodstuffs. Colitis may cause thickening of the 
valve and partial obstruction. Recent observations 
have shown that the valve is sometimes too small 
at birth, causing congenital constipation. This 





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Marked ileac stasis. Roentgenogram made nine and a half 
hours after barium meal. Arrows a, b and c point to several 
coils of the terminal ileum still filled at this hour. The re- 
mainder of the barium is in the colon, where it all should 
have been before the ninth hour. (Case.) 



DISORDERS OF THE DIGESTIVE TUBE 145 

form of incompetency of the valve is fortunately 
very rare, and like others may be remedied. 

Incompetency is both a consequence and a cause 
of constipation. The valve is often rendered in- 
competent by over-stretching of the bowel, usually 
the result of obstruction in the descending or 
pelvic colon. When once the valve is crippled, the 
constipation is made worse by the loss of the check- 
valve action which aids the forward movement of 
the bowel contents, so that the food residues oscil- 
late back and forth between the large and the 
small bowel, until the water content is so much re- 
duced that a pasty mass is formed, which is pushed 
forward only with great difficulty by the bowel, 
which at this point is adapted to dealing with thin 
liquids rather than semi-solid adhesive materials. 

The stagnation resulting from this condition 
readily leads to infection of the cecum and appendi- 
citis, and to more remote affections, through ex- 
tension of the infection backward along the small 
intestine to the duodenum, stomach, gall-bladder, 
liver and pancreas, causing inflammation of the gall 
ducts and gall-bladder, gall-stones, pancreatitis and 
possibly diabetes, duodenal and gastric ulcers, and 
various other allied affections. 

Delay at the Hepatic Flexure 

The cecum is a rather thin walled pouch, in- 
tended only for holding a small amount of liquid 
for a comparatively short time. When the bowels 



146 COLON HYGIENE 

are restrained from normal action, by resisting the 
"call" for evacuation, the cecum becomes filled by 
the backing up of semi-solid feces, which cause it 
to sag down, and in time dilate and displace it. 
The over-filled and heavy cecum drags heavily 
upon the hepatic flexure, and so narrows the pas- 
sage along the colon at this point as to produce 
partial obstruction and delay in the movement of 
feces from the cecum over into the transverse 
colon. The observations of Virchow, Lane and 
others have shown that adhesions are often found 
at this point, which narrow the bowel and pro- 
duce more or less obstruction and delay. 

Delay at the Splenic Flexure 

At the splenic flexure the bowel forms a very 
acute angle, so that the colon is narrower at this 
point than at any other. The overloading of the 
transverse colon, which results from gross neglect 
to attend promptly to the "call" of Nature, drags 
heavily upon the splenic flexure, and causes such 
narrowing of the bowel as to result in very con- 
siderable obstruction and delay. 

As the feces are banked up in the transverse 
colon, this segment of the intestines sags more and 
more until it may be stretched to the very bottom 
of the pelvis. This process of prolapse is, of course, 
greatly favored by weakness of the abdominal 
muscles. 



DISORDERS OF THE DIGESTIVE TUBE 147 
Delay at the Pelvi-rectal Junction 

The passage from the colon to the rec- 
tum, which is closed and opened by the falling 
and rising of the pelvic loop of the colon, 
is sometimes obstructed by thickening due to in- 
flammation or ulceration. Sometimes the pelvic 
colon becomes adherent to the pelvic floor so that 
it cannot rise, and there is more or less obstruction 
to the passage of feces into the rectum. In such a 
case, there must of necessity be an accumulation of 
feces in the lower bowel above the rectum, and 
as a consequence cumulative constipation will be 
found present. 

The inflammatory process by which adhesions 
and thickenings are produced is easily set up by the 
colitis and other infections which are the natural 
consequence of retention of feces in the bowel for 
an undue length of time, such as results from 
postponing the evacuation of the bowels, or from 
excessive dryness of the stool from any cause. 
Stasis, that is, delay of fecal matters at any point 
in their journey through the colon, is likely to be 
followed by inflammation not only within the 
bowel but in the whole thickness of the bowel wall 
and on its outer surface, thus leading to adhesions 
and loss of contractile power. An inflamed and 
thickened bowel is always crippled and incapable 
of contracting upon the bowel contents in a normal 
way. 



148 COLON HYGIENE 

Thickening of Houston's Valves 

It is believed by some surgeons that these mem- 
branous valves sometimes become so thickened as 
to form an obstruction to the passage of feces. The 
writer has seen no cases of this sort, although he 
has carefully looked for them in hundreds of 
cases. 

Delay at the Outlet 

Failure of the anus to relax when the colon con- 
tracts interferes seriously with defecation, and may 
prevent movement of the bowels. This may re- 
sult from various causes, as a weak stimulus from 
the defecation center, or unduly contracted anal 
muscles. This point will be considered further in 
another connection. 

Kinks 

Virchow was the first to observe the conditions 
to which Mr. Lane, an eminent London surgeon, 
first applied the term "kinks," but his observations 
received little attention until within recent years. 
Mr. Lane has shown the important relation which 
they bear to the functions of the colon and to 
general conditions of the body arising from auto- 
intoxication. 

The narrowing which occurs from folding of 
the bowel or compression by bands, is usually the 
result of adhesions. The obstruction thus pro- 



DISORDERS OF THE DIGESTIVE TUBE 149 

duced causes stasis, or stagnation, and increase of 
putrefactive changes in the foodstuffs, with infec- 
tions of the intestine, from which come still further 
thickening and narrowing of the bowel, and so 
continual increase of delay and of constipation. 

The pelvic loop sometimes becomes so much 
elongated that when it is emptied and falls over 
backward into the pelvis it makes several folds 
upon itself. If adhesions form an extension of infec- 
tion through the wall to the outer surface, as they 
sometimes do from pericolitis, "kinks" are developed 
which may require surgical means of relief. 

"Lane's Kink" 

Within the last dozen years there has been much 
discussion in medical circles about a "kink" located 
at the lower end of the small intestine within a 
few inches of the ileocecal valve. Lane, of Lon- 
don, has attributed to these adhesions of the terminal 
ileum stasis or stagnation of materials in the ileum, 
and most of the disease conditions which develop in 
the stomach, liver, duodenum, gall-bladder and pan- 
creas. 

Recent observations made at the operating table 
by the writer and others, clearly show, however, that 
"Lane's Kink" is practically always associated with 
incompetency of the ileocecal valve. It seems most 
probable that adhesions of the lower end of the 
ileum are the result of inflammation caused by the 



150 COLON HYGIENE 

backing up of fecal matters into the small intestine 
through the open valve. It has also been observed 
that these "ileal kinks," first mentioned by Lane, 
are seldom obstructive, the real cause of the delay in 
the small intestine associated with "kinks" being 
incompetency of the ileocecal valve, which also is 
the cause of the "kink." 

Mechanical Effects of Constipation 

Fecal accumulations in the rectum, and in some 
cases possibly also accumulations in the pelvic colon 
and in the caecum, may give rise to various reflex 
pains on account of pressure. Pain in the buttocks 
and the back of the thigh, and a dull pain in the 
region of the sacrum is often due to the pressure of 
fecal matters in the rectum. Neuralgia of the 
testicles and of the ovaries, and dysmenorrhea in 
young women, is often traceable to this cause. Ab- 
normal sexual excitability, especially during sleep, 
is also sometimes traceable to accumulations in the 
rectum. Itching about the anus, is often caused 
by the pressure of a small amount of fecal matter 
in the anal canal, disappearing at once when the 
feces are removed. Hemorrhoids may be caused by 
the pressure of fecal matters upon the hemorrhoidal 
veins; and varicocele, if not produced, is certainly 
aggravated by accumulations of fecal matters in the 
iliac colon. 

Headache and sometimes vertigo and a sensation 






DISORDERS OF THE DIGESTIVE TUBE 151 

of exhaustion and depression are symptoms com- 
monly experienced by persons suffering from cumu- 
lative constipation. These symptoms may be the 
result of reflex action, which seems most probable, 
or they may be in whole or in part the result of 
chronic poisoning due to the absorption of long 
retained fecal matters. The fact that the symptoms 
disappear almost immediately when the bowel is 
emptied by an enema, does not necessarily indicate 
that the act is reflex. Effects due to autointoxication 
are the result of over-saturation of the blood with 
poisons derived from the bowel contents. When, 
by removal of the source of the poisons, the intake 
ceases, the liver and kidneys quickly clear the blood 
of the subtle intoxicants, and the nerve disturbance 
ceases. 

The Bad Effects of Straining 

The violent straining occasioned by the presence 
of dry and hard feces in the rectum and lower colon 
is not merely an inconvenience, but often results in 
serious and sometimes fatal injury. 

One of the most common results of straining at 
stool, especially when prolonged or repeated several 
times daily, is hemorrhoids, or piles. These are 
excrescences which form just in the anus, or at its 
lower edge. The accumulation of fecal matters in 
the rectum obstructs the flow of blood in the veins 
which have their origin at this point, and in straining 
these veins become greatly distended with blood; 



152 COLON HYGIENE 

their walls become thickened, forming irregular 
masses which are usually forced out when the bowels 
move. As the result of the straining, and often 
as the result of the use of rough toilet paper, the deli- 
cate mucous membrane becomes abraded or cracked, 
infection occurs, and the hemorrhoids become in- 
flamed and swollen causing still further thickening. 
Thus the hemorrhoids gradually increase in size, un- 
til they may become so large that the anal sphincters 
are over-stretched and become relaxed, and in time 
the rectum may be pushed outside whenever the 
bowels move. Prolapse of the rectum is most likely 
to occur in children and emaciated adults. 

In persons suffering from arteriosclerosis or de- 
generation of the blood-vessels, especially aged per- 
sons, straining at stool may cause rupture of a blood 
vessel and sudden death. In angina pectoris a 
spasm may result from straining at stool, sudden 
death having been known to occur in cases in which 
the heart was very feeble. 

Stricture 

The bowel may be narrowed by the contraction 
of the scar left behind by a healed ulcer due to tuber- 
culosis, typhoid fever or other cause. When such 
strictures are present, the peristaltic movements of 
the intestine are often so strong as to be visible in 
a thin patient through the abdominal walls. Such 
cases require operation. 



DISORDERS OF THE DIGESTIVE TUBE 153 

Cancers and Tumors 

Cancer of the colon is not infrequent, constitut- 
ing about nine per cent of all cancers. Cancer 
occurs most frequently in the cecum or ascending 
colon, and next most frequently in the rectum or 
pelvic colon, points at which the greatest de- 
lay of the feces occurs. 

Cancer of the colon is not infrequently secondary 
to cancer in some other location. When cancer 
exists or has existed in the breast, stomach, or else- 
where, obstinate constipation should lead to a care- 
ful physical examination including an X-ray ex- 
amination of the colon with special reference to 
the presence of organic obstruction. 

Intussusception 

Acute obstruction due to "telescoping" of the 
intestine requires immediate surgical attention. 

Chronic constipation is held to be sometimes 
due to such a telescoping of the pelvic colon into 
the rectum. This condition is probably quite 
rare, but it possibly may be more frequent than 
has been hitherto supposed. Such cases require 
surgical attention. 

Disturbance of the Discharging Mechanism 

The feces are formed by the gradual absorption 
of the digested foodstuffs, and the drying out of 



154 COLON HYGIENE 

the mass of debris left through the absorption of 
water. When thus formed, the feces are slowly 
moved along the colon toward the lowermost part 
of the colon proper, the pelvic colon, where they 
are deposited, the pelvic loop filling from below 
upward. The filling begins at the bottom of the 
loop, the junction of the colon with the rectum. 

At this point a new mechanism is provided to 
deal with the feces. They have become so dried 
and hardened by the absorption of their liquid 
part that they are no longer suited for transpor- 
tation by the feeble peristaltic waves which con- 
tinually course from one end of the intestinal tract 
to the other. They must be dealt with by a more 
powerful mechanism. This may be termed the 
discharging mechanism or device, and it is certainly 
a most remarkable apparatus. We need not repeat 
here the description of the process of defecation, 
which has been given in detail elsewhere. Briefly 
summarized, it consists of three voluntary and four 
involuntary acts. 

1. Voluntary acts in defecation: (a) Con- 
traction of the diaphragm, (b) Contraction of the 
abdominal muscles, (c) Compression of the abdo- 
men by the thighs. 

2. Ivoluntary acts in defecation: (a) Con- 
traction of the colon, (b) Relaxation of opening of 
the anus, (c) Reinforced contraction of the ab- 
dominal muscles, (d) Strong contraction of the 
levator ani muscles lying behind the rectum. 



DISORDERS OF THE DIGESTIVE TUBE 155 

When each of these several distinct voluntary 
and involuntary acts is promptly and efficiently 
performed, defecation is complete, and at least the 
lower half of the colon is completely emptied. 
Failure at any point results in incomplete defeca- 
tion, and fecal matters are left behind, producing 
cumulative constipation. Let us note the different 
ways in which these several acts may be interfered 
with. 

Weak Contraction of the Diaphragm 

If the diaphragm is weak from disuse or general 
feebleness, if its movements are obstructed by cor- 
sets or w T aist bands, if it is tied fast by adhesions 
from pleurisy or crippled by hernia, it cannot act 
efficiently, and the amount of feces pushed down 
into the rectum may not be sufficient to call forth 
a vigorous act of defecation. The result will be 
that the colon will be only partially emptied, and 
cumulative constipation will result, though the 
rectum may be fully emptied and no sense of dis- 
comfort be felt. The pelvic colon will be grad- 
ually stretched by the accumulating contents until 
it becomes enormously enlarged and forms a reser- 
voir of putrefying feces, by which the body is con- 
tinually poisoned, and a great variety of diseased 
conditions produced. This condition is very com- 
mon as the natural result of sedentary habits and 
corset-wearing. 



156 COLON HYGIENE 

Feeble Contraction of the Abdominal 
Muscles 

When the abdominal muscles are weak, relaxed, 
separated, or otherwise inefficient, the results are 
the same as when the diaphragm fails to do its 
duty, for the two sets of muscles must work in co- 
operation. 

The ordinary water-closet seat renders complete 
efficiency of the abdominal muscles and diaphragm 
practically impossible, since it does not permit of 
pressure by the thighs, an essential voluntary act 
in defecation. 

Deficient Contraction of the Colon 

A feeble, dilated, inflamed, thickened, elongated, 
adherent, overloaded, obstructed colon, cannot 
possibly contract with sufficient vigor to empty it- 
self of its unclean contents. Yet such is the chronic 
condition of the colon in a very large proportion 
of cases as the result of the operation of some one 
or more of the causes which have been enumerated 
in the foregoing paragraphs. 

Nervousness, apprehension or fear may prevent 
the normal reflex from acting. Hysteria or melan- 
cholia may paralyze a patient's colon as well as an 
arm or a leg. 

Injured Levator Ani Muscles 

When these muscles are crippled so that they 
cannot contract properly, the rectum is not emptied 



DISORDERS OF THE DIGESTIVE TUBE 157 

but remains relaxed and filled with feces, which 
give rise to much annoyance, and may become a 
cause of rectal ulceration and hemorrhoids. The 
levator ani muscles are often damaged by lacera- 
tions at childbirth, or by the prolonged contact 
with hardened feces, which gives rise to atrophic 
changes. Laceration of the perineum permits the 
pelvic floor and anus to bulge forward, stretching 
the rectum and thus creating a wide reservoir for 
feces. 

Anal Disease 

Pain arising from ulcer, fissure, fistula or in- 
flamed hemorrhoids may cause so strong a con- 
traction of the anal sphincters that they fail to re- 
lax at the command of the defecation center, so 
that the bowel must force the feces down through 
the rectum in opposition to these muscles. This 
condition exists more frequently than was formerly 
supposed. Many cases of obstinate constipation 
have been cured by an operation for removal of 
painful hemorrhoids or relief of a painful ulcer or 
fistula. 

Pregnancy, extreme retroversion of the uterus, 
an enlarged and painful prostate, malignant or 
other growths in or about the rectum, and in wo- 
men, rectocele, from laceration of the perineum, 
are causes of interference with the proper action 
of the defecating mechanism. 

The usual result of this defective action is to 



158 COLON HYGIENE 

leave a quantity of feces in the rectum or the pelvic 
colon or in both cavities. The retained feces be- 
come dry and hard, sometimes to a surprising de- 
gree, and form a mechanical obstruction which re- 
sults in a damming back of the feces which are 
left to accumulate in sections of the colon higher 
up. 

Loss of Rectal Reflex 

The key to the automatic or involuntary act of 
defecation is the rectal reflex, which is discharged 
by contact of the feces with the walls of the rectum. 
The long retention of feces in contact with the 
rectal nerves destroys their sensibility and so the 
reflex is lost. This is one of the worst results of 
the disturbances in the defecating mechanism, 
which have been above enumerated. Patients suffer- 
ing with this form of constipation often report that 
they have felt no desire for evacuation of the 
bowels for years. The loss of hearing, or even of 
the sense of sight, would really be less of a 
calamity in many cases than the permanent loss 
of this useful reflex, which is one of the most im- 
portant protective mechanisms with which the body- 
is provided. Fortunately, however, the reflex 
generally may be restored. 

Disease of the spinal cord may permanently de- 
stroy the defecatory center. Constipation is some 
times a most troublesome symptom in locomotor 
ataxia. 



Alimentary Toxemia or Intestinal 
Autointoxication 

Bouchard, an eminent French physician, was 
first to coin the word autointoxication, and to point 
out the various ways in which the disease may be 
produced by poisons generated in the body. He 
called special attention to the fact that the intes- 
tine, and especially the colon, is a prolific source 
of poisons. Some of these poisons are excreted by 
the liver. The bile, as shown by Bouchard, is six: 
times as poisonous as the urine, producing poison 
enough within ten hours to cause death. The 
mucous membrane of the intestine has been shown 
to be another source of highly active poisons, 
which are separated from the blood by the mucous 
membrane and thrown into the cavity of the in- 
testine to be removed from the body. 

Still another source of intestinal poisons is the 
putrefaction of that portion of the protein of the 
food which fails to undergo absorption. 

The bile, mucous, and other secretions of the 
intestine and the adjacent glands also undergo put- 
refaction when conditions are favorable. 

This putrefactive process is, as shown by 
Pasteur, the result of the growth of certain forms 
of bacteria. These putrefactive bacteria are found 
everywhere. They are present in great num- 

159 



160 COLON HYGIENE 

bers wherever putrefaction is taking place. The 
flesh of every dead animal is filled with teeming 
millions of these poison-forming microbes within a 
few hours after death. A piece of flesh taken from 
an animal just killed, and placed in a tightly sealed 
glass jar, will be found in a few days in an 
advanced state of putrefaction. Experiments of 
this kind were made by Professor Tissier of the 
famous Pasteur Institute of Paris. He found it 
impossible to obtain meat so fresh that it did not 
contain bacteria of different species sufficient to 
produce complete putrefaction. As ordinarily 
eaten, the flesh of animals is always in a state of 
more or less advanced putrefaction, and hundreds 
of millions of living bacteria are found in every 
morsel. This is true even when the flesh has 
been cooked; ordinary cooking does not destroy 
the putrefactive bacteria. 

Commercial cow's milk also abounds with bac- 
teria, some of which are of putrefactive sort. Street 
dust consists very largely of putrefactive bacteria 
derived from animal feces which have been drop- 
ped in the street and ground into dust by passing 
vehicles. It is evident then, that the human intes- 
tine is very greatly exposed to infection by putre- 
factive bacteria; and it needs no argument to show 
that any delay ©f food residues capable of putre- 
faction, together with the bile, mucus, and other 
constituents of the feces, must result in the pro- 
duction of a large amount of intestinal poison. 



ALIMENTARY TOXEMIA 161 

In view of these facts, it is safe to say that the 
worst effects of constipation are those which 
arise from intestinal autointoxication. Not only 
Bouchard, but Tissier, Combe, Bourget, Lane of 
London, and a great number of able medical ex- 
perts in all parts of the world have within the last 
few years recognized the great and far-reaching 
destructive effects of the absorption of bacterial 
poisons from the intestinal tract. 

It is entirely possible for a person to suffer from 
intestinal toxemia without constipation, as in 
cholera morbus, cholera infantum and summer 
diarrhoeas of infancy; but it is impossible to have 
constipation without intestinal autointoxication. 
The fact that the symptoms of toxemia do not oc- 
cur in every case is no evidence that they are not 
present. The body must be unduly exposed to 
toxic influences, even though it may possess to such 
an extraordinary degree the power to defend itself 
against these intestinal poisons that immediate visible 
effects do not appear. 

When the intestinal mucous membrane is intact, 
it is able to exclude most of the intestinal poisons, 
acting like a filter, which permits only the useful 
substances to enter the blood. The liver, the 
largest gland in the body, possesses the power to 
destroy poison to a considerable degree. There 
are various other organs of the body, such as the 
glands of internal secretion, of which the thyroid 



162 COLON HYGIENE 

gland is a conspicuous example, which aid in the 
destruction of poisons. The kidneys both destroy 
and eliminate poisons, and the skin and the lungs 
also share in this protective work. 

So long as the defensive powers of the body re- 
main intact, enormous quantities of poisons may be 
produced in the intestine without apparently evil 
results. This is the reason why many constipated 
persons seem to suffer no ill effects from intestinal 
inactivity. 

In every case, however, the time comes sooner 
or later when the intestinal filter no longer acts 
sufficiently in excluding poisonous matters — when 
the liver is no longer able to destroy all the poisons 
brought to the blood; when the thyroid and other 
glands have become worn out with over- activity ; 
when the kidneys have ceased to be able to main- 
tain the normal degree of blood purity by the ex- 
cretion of poisons. 

When the symptoms of toxemia appear, the fact 
shows that the poison-destroying mechanism of 
the body is broken down ; the great margin of safety 
which Nature provides against emergencies, has 
been used up; the defenses against autotoxins have 
been swept away, and the tissues are flooded with 
these subtle and mysterious disease-producing ele- 
ments. 

The simple and latent forms of constipation are 
those in which the symptoms of toxemia are specially 
prominent, for the reason that in these forms of 



ALIMENTARY TOXEMIA 163 

constipation the delay occurs in those portions of 
the digestive canal in which the intestinal contents 
are still fluid, a condition in the highest degree 
favorable to the growth of putrefactive bacteria. 
Besides being fluid, the contents of the small in- 
testine and first part of the colon contain a 
varying amount of protein, the food element on 
which putrefactive bacteria thrive, and from which 
alone they are able to produce their deadly toxins. 

In cumulative constipation, the protein is almost 
wholly absorbed before the lower colon is reached, 
and the amount of water is reduced to such an 
extent that putrefaction is necessarily limited, and 
the resulting autointoxication is proportionately 
less. 

In latent constipation, especially, the conditions 
are in a high degree favorable for the development 
of intestinal autointoxication. The stasis or stag- 
nation above the ileocecal valve affords conditions 
the most favorable for putrefaction and absorption 
of putrefactive products. It is evident, then, that 
the study of constipation cannot be complete with- 
out a thorough study of intestinal toxemia. This 
is especially true as regards the treatment of this 
condition both with reference to the causes of the 
constipation and its consequences. 

Bacteria of the Intestine 

Roger, the eminent successor of Bouchard, de- 
scribed no less than one hundred sixty different spec- 



164 COLON HYGIENE 

ies of bacteria which have been found in the alimen- 
tary canal. Many of these produce no poisons. Others 
produce simple organic acids which are under or- 
dinary circumstances harmless; still others produce 
alcohol, formic acid, butyric acid, and other sub- 
stances which are unquestionably toxic, although 
not appreciably so in the extremely minute quanti- 
ties in which they are produced in the intestine 
under strictly normal conditions. Still other mi- 
crobes, of which some scores of species are found 
in the intestine, produce subtle poisons which are 
capable of causing deadly effects, even in very 
minute quantities. Everyone is familiar with the 
unpleasant effects of the volatile substances which 
emanate from a mass of putrefying flesh. Head- 
ache, nausea, and other symptoms may result from 
the odors alone which arise from putrescent sub- 
stances. These volatile substances are poisonous, 
but other non-volatile poisons present are much more 
active. Some are almost as powerful as the venoms 
of snakes, which they resemble in chemical composi- 
tion. The South American Indian poisons the 
points of his deadly arrows by dipping them into 
putrid flesh. Butchers as well as undertakers some- 
times die as the result of a small cut made with a 
knife soiled by contact with a dead body. The 
same poisons are produced when putrefaction takes 
place in the intestine. 

None of the intestinal microbes are essential for 
life or health. Pasteur supposed that all life was 



ALIMENTARY TOXEMIA 165 

dependent upon microbes. One of his pupils, 
Roux, showed this idea to be erroneous, at least as 
regards vegetables, by causing beans to grow in 
sterile soil and sterile water. Pasteur admitted his 
error in regard to vegetable organism, but still 
maintained that animals could not live without the 
aid of intestinal bacteria. Nuttall and Thierfelder, 
by experiments with guinea pigs, showed that these 
animals could be brought into the world free from 
germs, and made to grow on food which contained 
no trace of bacteria. When the animals were killed, 
no bacteria were found in their intestines. Recent 
experiments made by Roux showed that chickens 
hatched and grown under sterile conditions thrived 
better than chickens hatched under ordinary condi- 
tions. 

Numerous other experiments have confirmed 
this fact, but most important of all were the obser- 
vations of Levin at Spitzbergen, in the Arctic reg- 
ion. This observer made careful examination of 
scores of Arctic animals, and found that in the 
majority of cases no bacteria were present in the 
intestine. This fact will be easily understood 
when the additional fact is known that the air, and 
even sea-water, are in these cold regions practically 
free from bacteria. 

The fact that bacteria are present in the human 
intestine is therefore no evidence that they supply 
any human need. The presence of these minute 
parasites is, instead, an unfortunate incident of our 



166 COLON HYGIENE 

existence. Metchnikoff has shown that colon germs 
in no way contribute to our well-being, but on the 
contrary, are an undoubted cause of premature 
senility, and the unnatural abbreviation of human 
life, the sad lot of the average man. 

Acid-Forming Bacteria 

Professor Tissier, of Paris, well known as one 
of the leading savants of the renowned Pasteur 
Institute, many years ago made a profound study of 
the bacteria of the intestine and established the 
fact, which had been previously observed by Es- 
cherich and others, that the intestine of a new born 
babe is absolutely free from bacteria. Tissier made 
an extended research of the manner of the invasion 
of the intestine of the young child by bacteria. He 
found that within about seven hours in summer 
time, and twenty hours in winter time, when bac- 
teria are less abundant in the air, the intestine of 
the recently born child is found to be swarming 
with bacteria, many of which are of the putrefactive 
sort. Within a few days, however, the putrefactive 
bacteria disappear, and a peculiarly shaped acid- 
forming microbe, to which Professor Tissier gave 
the name Bacillus bifidus, takes their place. 

This observation was of the greatest importance. 
It reveals the beneficent plan of Nature, by which 
the young infant is protected from the deadly effects 
of putrefactive organisms. So long as the Bacillus 



ALIMENTARY TOXEMIA 167 

bifidus continues to hold its place as the dominant 
microbe of the child's intestine, the stools are slightly- 
acid and the little one enjoys perfect health. The 
child's intestine may be compared to a flower 
garden which is so completely occupied by flowers 
that there is no room for the growth of noxious 
weeds. 

As the child becomes older, and is fed upon 
cow's milk, meat, and other foodstuffs which con- 
tain putrefactive organisms, and is no longer nursed 
at the breast, the Bacillus bifldus becomes less promi- 
nent in the stools, putrefactive bacteria make their 
appearance, the child becomes subject to constipa- 
tion and diarrhoeas, and the troubles of life begin. 
The stools, instead of being acid, acquire a foul 
odor. In many instances, such symptoms of chronic 
autointoxication, as rickets, scurvy, arrested growth, 
emaciation, decay of the teeth, nasal catarrh, and 
other evidences of physical weakness make their 
appearance. 

Infantile convulsions, night terrors, grinding the 
teeth during sleep, fitfulness, feverishness, and num- 
erous other symptoms of nervous disturbance in 
infants, are directly due to poisoning as the result of 
constipation, with intestinal putrefaction. So long 
as the stool remains normally acid, constipation 
does not occur, but when putrefaction and foul- 
smelling feces occur then constipation appears with 
a great variety of nervous and other symptoms which 
are a natural consequence. 



168 COLON HYGIENE 

A few years ago Massol, of Geneva, in study- 
ing certain Bulgarian milk preparations discovered 
a new lactic-acid-forming ferment. In testing its 
properties he discovered that it possessed the faculty 
of producing lactic acid in far greater quantities than 
any other known ferment. The eminent Professor 
Metchnikoff, of the Pasteur Institute, at once recog- 
nized the value of this new discovery, and after a 
careful study of the ferment, did not hesitate to 
recommend it as a most important means of com- 
bating many of the gravest forms of chronic disease, 
and especially that most inveterate of all human 
maladies, old age. 

Professor Metchnikoff has long held the theory 
that old. age, as well as many common chronic dis- 
orders, is due to poisons absorbed from the intes- 
tines. These poisons are formed by certain germs 
known as anaerobes. Some of these germs are found 
in such great quantities in butcher's meat that Herte** 
has given to them the name "meat bacteria." By 
the use of meat these germs are introduced into 
the intestine in great numbers. The poisons formed 
by these germs are extremely virulent, and when 
taken into the body, gradually break down the 
liver, kidneys, and other defensive organs, and so 
give rise to a large number of very common and 
very serious diseases. This chronic poisoning first 
makes its appearance in acute attacks, such as sick 
headache, nervous headache, loss of appetite, coated 
tongue, bilious attacks, irregular action of the 



ALIMENTARY TOXEMIA 169 

bowels, diarrhea, appendicitis, febrile attacks resem- 
bling malaria, and insomnia. 

As the system becomes more and more saturated 
with these poisons through the gradual failure of 
the liver and kidneys and the constant multiplication 
of the bacteria, other more chronic symptoms appear, 
such as constant headache, mental confusion, neuras- 
thenia, nervous exhaustion, gall-stones, hemorrhoids, 
emaciation, browning of the skin, particularly about 
the eyes, various skin diseases, especially acne, ec- 
zema, psoriasis and urticaria, neuralgia, pain and 
stiffness of the joints. After a time still worse con- 
ditions make their appearance, such as Bright's dis- 
ease, sclerosis or hardening of the liver, dropsy, 
chronic rheumatism, and rheumatic gout. 

Chronic autointoxication is unquestionably a 
factor in nearly all chronic disorders, and lays the 
foundation for tuberculosis, cancer of the stomach, 
ulcer of the stomach, and other gastric disorders. 
Many women supposed to be suffering from dis- 
orders peculiar to their sex, are really suffering only 
from autointoxication, which is the natural result 
of prolapse of the viscera, colitis, and inattention to 
the hygiene of the bowels. 

It has long been known that the conditions above 
mentioned may be greatly relieved by the use of 
buttermilk and kumyss, but these remedies have 
never gained very great confidence for the rea- 
son that, while they have seemed to succeed remark- 
ably in certain cases, in the majority of cases the 



170 COLON HYGIENE 

relief obtained has been very temporary, and often 
their use has been attended by complete failure. 
The reason for this was the fact that the lactic fer- 
ment of kumyss and buttermilk is not able to live 
in the large intestine. This is the particular part 
of the alimentary canal in which the poison-forming 
anaerobes are found in largest numbers, especially in 
the cecum. 

Tissier's experiments showed that the Bulgarian 
lactic ferment has such great vitality that it is able to 
live in the colon. Its great activity in the formation 
of acids enables it to kill off the anaerobes which can 
live only in an alkaline medium. Fortunately the 
new ferment is harmless, so that a person who is 
suffering from autointoxication may, by introducing 
into his alimentary canal a sufficient amount of the 
lactic ferment, drive out the poison-forming germs, 
or at least reduce their numbers to a very great ex- 
tent. The importance of doing this will be realized 
when it is known that the poisons which they form 
are among the most highly toxic known. This is the 
reason that constipation produces headache, and that 
diarrhea is accompanied by such great exhaustion. 
The headache and the prostration are simply results 
of the poisons which are absorbed from the infected 
intestines. 

This ferment has been known for ages in Bul- 
garia and the Orient generally. In Egypt it is 
known as leben. In these countries a milk prepara- 
tion containing the ferment is prepared by steriliz- 



ALIMENTARY TOXEMIA 171 

ing the milk and adding the ferment to it. It 
possesses the particular advantage that it does not 
produce alcohol as does the kumyss ferment, and 
when properly cultivated, it does not produce dis- 
agreeable flavors by decomposing the caseins and 
fats of the milk. 

The use of the ferment has extended rapidly in 
France and Switzerland, and has lately been intro- 
duced into this country. For those who like milk 
and are able to digest it readily, the milk prepara- 
tion is very satisfactory, although the preparation 
of the milk requires considerable care and pains to 
prevent contamination. There are many, however, 
with whom milk does not agree. Such persons 
have been termed by Combe "casein dyspeptics." 
For the benefit of such cases concentrated prepa- 
rations of the ferment have been devised. Pure 
cultures of the ferment are made in a bacteriological 
laboratory and in concentrated form are made into 
tablets. Three or four of these tablets taken after 
or at meals in connection with a proper dietary, — 
especially with the free use of farinaceous foods, and 
maltose in the form of malt extracts or meltose — 
develop rapidly, and by driving out the invading 
anaerobes, stop the formation of poisons and give the 
body an opportunity to clear itself from the accumu- 
lated toxins, and thus establish conditions which 
render recovery possible. Those who like milk, but 
do not like it sour, may take it in its ordinary form, 
adding the tablets. 



172 COLON HYGIENE 

It is, of course, evident that a person adopting 
this method should discontinue the use of meat en- 
tirely, and should not use eggs freely. 

Ancient Latin authors mention the use of sour 
milk preparations by the primitive tribes which occu- 
pied the country now inhabited by the Bulgarians 
and other Balkan people by whom the Bulgarian 
ferment is widely used. 

The natives of Mesopotamia, living about Mount 
Ararat make large use of the same ferment, which 
they declare was preserved for them by the antedilu- 
vian Noah; and it is certain that this ferment and 
buttermilk prepared from it was well known to 
Abraham and the other Hebrew patriarchs whose 
use of it is mentioned in the Scriptures. 

Natives of northern India make large use of a 
sour milk preparation called dahi. An examina- 
tion of a sample of this preparation, sent to us from 
a friend living in Darjeeling, India, showed that it 
contained an acid-forming organism identical with 
the Bacillus Bulgaricus. A few years ago a medical 
friend whom the author met in Edinburgh, Dr. 
Matthieason, of Iceland, described to him a sour milk 
preparation used in that country, known as "skyr," 
which is made by first adding to the milk a "starter," 
to which rennin is then added to curdle it. The 
curd is separated from the whey and packed in casks 
or barrels. Melted paraffin is poured over the sur- 
face to preserve it. In this way it is kept for many 
months, and is a valuable source of food in the win- 



ALIMENTARY TOXEMIA 173 

ter season when milk is scarce. Doctor Matthieason 
states that this product is found a highly efficient 
remedy in relieving acute gastric and intestinal dis- 
orders due to excessive meat-eating which is very 
common in Iceland. A bacteriological study of skyr 
made in the laboratory of the Battle Creek Sani- 
tarium showed that it contains an acid-forming 
organism resembling the Bacillus Bulgaricus which 
grows very vigorously and produces large quantities 
of lactic acid. 

It thus appears that the use of lactic acid ferments 
is a practice known to widely scattered nations and 
from the most ancient times. The great care which 
is taken by the most primitive people to preserve the 
purity of the particular ferment which they employ, 
and the high value which they place upon it in the 
treatment of many diseases, leads one to wonder 
that civilized people should have been so slow to 
avail themselves of this valuable means of com- 
batting some of the most dangerous and insidious 
of the foes of human life. 

Alimentary Toxemia 

The condition known as intestinal autointoxica- 
tion, intestinal toxemia, and more recently termed 
alimentary toxemia, is one of the natural and most 
far-reaching consequences of constipation and intes- 
tinal stasis. All foodstuffs are capable of under- 
going destructive change as the result of the action 



174 COLON HYGIENE 

of germs upon them. Starches, dextrines, and sugars 
(carbohydrates) ferment, while proteins putrify. 
The products of the fermentation of carbohydrates 
are acids which are harmless in the quantities in 
which they are produced in the body. The products 
of putrefaction are ptomaines, ammonia, and toxins, 
all poisonous substances. Some of the ptomaines, 
and toxins are closely akin to the venoms of poison- 
ous serpents, and like them, are very active even in 
very small quantities. 

When there is delay in the movement of food- 
stuffs along the digestive tract, fermentations or 
putrefactions quickly begin. The immediate re- 
sult will be the formation of odorless gases in the 
intestines, with sour-smelling stools, if starch or 
sugar is present in sufficient amount to give rise 
to fermentation. If protein and fats are present 
in large amount, then the result of delay will be 
putrefaction and the formation of foul-smelling 
gases and putrid stools. The sour stools of a 
healthy infant may be put aside in a bottle, and will 
undergo no change for an indefinite time. An 
infusion of such stools may be injected into a small 
animal without injury. An infusion from a putrid 
stool, seething with the putrefaction of undigested 
remnants of protein foodstuffs such as beefsteak, 
mutton chops, pork, etc., will kill an animal very 
quickly. Such a stool is swarming with deadly 
bacteria, and is saturated with their poisons. Very 
often these putrid masses have remained in the body 



ALIMENTARY TOXEMIA 175 

for many hours or even days, during which time the 
absorbents of the intestine are constantly sucking 
up the poisons and distributing them throughout 
the body, so that every cell and tissue is bathed 
with them. 

At first the evil effects of this systematic poison- 
ing do not appear. Indeed, many years may elapse 
before serious consequences make their appearance. 
The reason for this is that the body is provided 
with means of defence. The mucous membrane 
acts as a filter to exclude poisons. The liver de- 
stroys poisons. The thyroid gland, the suprarenal 
capsules, and probably the spleen and several organs, 
aid in the destruction of poisons. The suprarenal 
glands are believed to be especially active in de- 
stroying the poisonous pigments which are produced 
by putrefaction in the intestine. After a longer 
or shorter time these defences break down. The 
mucous membrane becomes the seat of infection, — 
colitis, — and allows a much larger quantity of 
poisons to pass into the blood stream. The liver, 
thyroid, and other poison-destroying organs become 
damaged by overwork, and fail to keep the blood 
clear of poisons. The kidneys are enormously over^ 
worked in their efforts to remove these deadly 
poisons from the blood, and so lose their efficiency. 
Now the effects of chronic poisoning begin to make 
their appearance. Every organ and every function 
of the body shows evidence of damage. The poisons 
circulating in the blood irritate the walls of the 



176 COLON HYGIENE 

blood vessels and cause first contraction, then hare - 
ening and degeneration, or arteriosclerosis. The 
brain and nerves show evidences of depression or 
irritation, according to the nature of the dominat- 
ing poisons. Headaches, neuralgia, neuritis, paraly- 
sis, mental dullness, neurasthenia, even insanity, 
are the results. Diseases of the liver, thyroid gland 
and spleen develop. Skin diseases of various kinds, 
and every sort of bodily derangement, are seen. 



Important Discussion of Alimen- 
tary Toxemia Before the 
Royal Society of Medi- 
cine of Great Britain 

About two years ago the subject of alimentary 
toxemia was discussed in London before the Royal 
Society of Medicine, by fifty-seven of the leading 
physicians of Great Britain. Among the speakers 
were eminent surgeons, physicians, and specialists in 
the various branches of medicine. 

Poisons of Alimentary Intestinal Toxemia 

The following is a list of the various poisons 
noted by the several speakers: Indol, skatol, phenol, 
cresol, indican, sulphuretted hydrogen, ammonia, 
histidine, urobilin, methylmercaptan, tetramethy- 
lendiamin, pentamethylendiamine, putrescin, cadav- 
erin, lecithin, neurin, cholin, muscarine, butyric 
acid, beta-imidazolethylamine, methylgadinine, 
ptomatropine, botulin, mytilotoxin, mytilo-conges- 
tine, oxybetaine, tyramine, agmatine, tryptophane, 
sepsin, indolethylamine, sulphemoglobine. 

Of the thirty-six poisons mentioned above, several 
are highly active, producing most profound effects, 
and in very small quantities. In cases of alimentary 
toxemia some one or several of these poisons is 

177 



178 COLON HYGIENE 

constantly bathing the delicate body cells, and 
setting up changes which finally result in grave 
disease. 

Symptoms and Diseases Due to Alimentary 
Toxemia 

It should be understood that these findings are 
not mere theories, but are the results of demonstra- 
tion in actual practice by eminent physicians. Of 
course it is not claimed that alimentary toxemia 
is the only cause of all the symptoms and diseases 
named: Although of many it may be the sole or 
principal cause, some of them are due to other causes 
as well. 

In the following summary the various symptoms 
and disorders mentioned in the discussion in Lon- 
don, to which reference has been made above, are 
grouped and classified. 

The Digestive Organs 

Duodenal ulcer causing partial or complete ob- 
struction of the duodenum; pyloric spasm; pyloric 
obstruction; distension and dilatation of the 
stomach; gastric ulcer; cancer of the stomach; ad- 
hesions of the omentum to the stomach and liver; 
inflammation of the liver; cancer of the liver. 

The muscular wall of the intestine as well as 
other muscles, atrophies, so that the passage of their 
contents is hindered. The abdominal viscera lose 




Healthy and Hardened Arteries 




HWVAM- ftKTE^Y 



Sectional View of a Healthy Artery and Arteriosclerosis 



DISCUSSION OF ALIMENTARY TOXEMIA 179 

their normal relationship to the spine and to each 
other, on account of weakening of the abdominal 
muscles; these displacements are much more marked 
and serious in women. Other conditions are: 
Catarrh of the intestines; foul gases and foul- 
smelling stools; colitis; acute enteritis; appendicitis, 
acute and chronic; adhesions and "kinks" of the 
intestine; visceroptosis; enlargement of spleen; 
distended abdomen; tenderness of the abdomen; 
summer diarrhoea of children; inflammation of 
pancreas; chronic dragging abdominal pains; gas- 
tritis; cancer of pancreas; inflammatory changes of 
gall-bladder; cancer of gall-bladder; gallstones; 
degeneration of liver ; cirrhosis of liver ; infection of 
the gums, and decay of the teeth; ulcers in the 
mouth and pharynx. 

Heart and Blood- Vessels 

Wasting and weakening of the heart muscle; 
microbic cyanosis from breaking up of blood cells; 
fatty degeneration of the heart; endocarditis; myo- 
carditis; subnormal blood pressure; enlargement of 
the heart; the dilitation of the aorta; high blood 
pressure; arteriosclerosis; permanent dilatation of 
arteries. 

Dr. W. Bezley says: "There are a few phases 
of cardiovascular trouble (disease of heart and 
blood vessels) with which disorder of some part 
of the alimentary tract is not causatively associated." 



180 COLON HYGIENE 

The Nervous System 

Headaches of various kinds — frontal, occipital, 
temporal, dull or intense, hemicrania; headache of 
a character to lead to a mistaken diagnosis of brain 
tumor. Dr. Lane tells of a case where a surgeon 
had proposed an operation for the removal of a 
tumor from the frontal lobe of the brain; the diffi- 
culty was wholly removed by the exclusion of the 
colon. Acute neuralgia pains in the legs; neuri- 
tis; twitching of the eyes and of muscles of face, 
arms, legs, etc. Lassitude; irritability; disturbances 
of nervous system, varying from simple headaches 
to absolute collapse; mental and physical depression. 
"A medical man with neurasthenic symptoms and 
a belief that he was ruined, recovered after he left 
off taking an egg for breakfast." Insomnia; 
troubled sleep, unpleasant dreams; unrefreshing 
sleep, the patient awakening tired; excessive sleep- 
iness, patient falling asleep in the daytime; shivery 
sensations across lower spinal region; burning sen- 
sations in face, hands, etc; epileptiform tic; typhoid 
state; paralysis; chronic fatigue; horror of noises; 
morbid introspection; perverted moral feelings; 
melancholia, mania, loss of memory; difficulty of 
mental concentration; imbecility; insanity; delir- 
ium, coma. 

The Eyes 

Degenerative changes in the eye; inflammation 
of the lens; inflammation of the optic nerve; hard- 




Ulcer of the Stomach 



Cirrhosis of the Liver 



DISCUSSION OF ALIMENTARY TOXEMIA 18! 

ening of the lens; sclerotitis, sclerokeratitis ; iritis; 
iridocyclitis; cataract; recurrent hemorrhage in the 
retina; eyes dull and heavy. W. Long says: "As 
an ophthalmic surgeon, I can look forward full 
of hope to a future when those serious eye affec- 
tions will cease to occur, because the physician has 
taught mothers how to feed children properly, and 
the dental surgeon has impressed upon the popula- 
tion at large the importance of proper mastication 
and the hygiene of the mouth." 

The Skin 

Formation of wrinkles; thin, inelastic, starchy 
skin; pigmentation of the skin — yellow, brown, 
slate-black, blue; muddy complexion; offensive se- 
cretion from skin of flexures; thickening of the 
skin of the back of the upper arm; irritability of 
the skin; sweating of the palms of the hands and 
the soles of the feet; eruptions of the skin — sores 
and boils; pemphigus; pruritus; herpes; eczema; 
dermatitis ; lupus erythematosus ; acne rosacea ; cold, 
clammy extremities; dark circles under the eyes; 
seborrhcea; psoriasis; pityriasis; alopecia; lichen; 
planus; jaundice; "An infinitesimal amount of 
poison may suffice to cause skin eruption." 

Muscles and Joints 

Degeneration of the muscles; "Muscles waste 
and become soft and in advanced cases tear easily." 



182 COLON HYGIENE 

"In young life the muscular debility produces the 
deformities which are called dorsal excurvation, or 
round shoulders, lateral curvature, flat-foot, and 
knock-knee." "Weakness of abdominal muscles 
causes accumulation of feces in the pelvic colon, 
which renders evacuation of contents more and 
more difficult." Prominence of bones; rheumatic 
pains simulating sciatica and lumbago ; various mus- 
cular pains; muscular rheumatism; arthritis de- 
formans; synovitis; rickets; arthritis, acute and 
chronic. Tubercle, and rheumatoid arthritis are 
the direct result of intestinal intoxication. Dr. Lane 
says: "I do not believe it is possible for either of 
these diseases to obtain a foothold except in the 
presence of stasis." 

Genito-Urinary and Reproductive Organs 

Various displacements, distortions and diseases of 
the uterus ; change in the whole form and contour of 
woman; fibrosis of breast; wasting of breasts; in- 
duration of breasts; sub-acute and chronic masti- 
tis; cancer of breast; metritis and endometritis; in- 
fection of bladder especially in women; frequent 
urination; albumosuria; acute nephritis, movable 
kidney; floating kidney. Dr. Lane goes so far as 
to say: "Autointoxication plays so large a part in 
the development of diseases of the female genito- 
urinary apparatus, that they may be regarded by the 
gynecologist as a product of intestinal stasis." 



DISCUSSION OF ALIMENTARY TOXEMIA 183 

General Disorders and Disturbances of 
Nutrition 

Degeneration of the organs of elimination, es- 
pecially the liver, kidneys (Bright's disease) and 
spleen; pernicious anemia; lowered resistance to in- 
fection of all kinds; premature senile decay; retar- 
dation of growth in children, accompanied by men- 
tal irritability and muscular fatigue; adenoids; en- 
larged tonsils; scurvy; enlarged thyroid (goitre) ; 
various tumors of thyroid; Raynaud's disease. 

In those who apparently suffer no harm from 
constipation during a long series of years there is 
perhaps, as suggested by Hertz, a partial immuni- 
ty established. The writer has long believed that 
such an immunity is sometimes established in the 
very obstinate constipation which accompanies abso- 
lute fasting, because of the cleansing of the tongue 
and reappearance of appetite which often occurs 
at the end of the second or third week of the fast, 
a phenomenon very like that which appears in ty- 
phoid fever and other continued fevers. It must 
not be supposed, however, that even the establish- 
ment of so-called immunity insures the body against 
all injury. The labor of eliminating an enormous 
amount of virulent toxins, which falls upon the 
kidne)'s, damages the renal tissues and produces 
premature failure of these essential organs. Any 
process which develops toxins within the body is 
a menace to the life of the tissues and should be 



184 COLON HYGIENE 

suppressed as far as possible, and as quickly as pos- 
sible. 

The fact that symptoms of poisoning resulting 
from constipation do not apear at once is no evidence 
that injury is not done. Dr. Wm. Hunter in the 
course of the London discussion remarked that 
the fact that chronic constipation ''might exist 
in certain individuals as an almost permanent con- 
dition without apparently causing ill-health is due 
solely to the power and protective action of the 
liver. It is not any evidence of the comparative 
harmlessness of constipation per se, but only an 
evidence that some individuals possess the cecum 
and the colon of an ox, with the liver of a pig, 
capable of doing any amount of distoxication." 

In the face of such an array of evidence backed 
up by authority of nearly sixty eminent English 
physicians — and many hundreds of other English, 
German, and French physicians whose names might 
be added — it is no longer possible to ignore the 
importance of alimentary toxemia or autointoxica- 
tion as a factor in the production of disease. To 
no other single cause is it possible to attribute one- 
tenth as many various and widely diverse disorders. 
It may be said that almost every chronic disease 
known is directly or indirectly due to the influence 
of bacterial poisons absorbed from the intestine. 
The colon may be justly looked upon as a veritable 
Pandora's box, out of which come more human 
misery and suffering mental and moral as well as 
physical than from any other known source. 



DISCUSSION OF ALIMENTARY TOXEMIA 185 

The successful treatment of alimentary toxemia 
often taxes to the utmost the resources of the best 
equipped physician. Sometimes it is necessary to 
call in the services of the surgeon. 

It may be fairly said, however, that at least 
nine-tenths of the possible benefits to be derived 
from treatment is to be secured by combating in- 
testinal stagnation. By such regulation of diet 
and habits as to secure a thorough evacuation of 
the bowels at least three times a day, or after each 
meal, and by excluding from the diet flesh meats and 
other putresicible substances, more can be accom- 
plished toward eliminating from the intestine per- 
nicious parasitic organisms and the multitudinous 
poisons which they produce than all other means. 

The sources of the poison-forming bacteria 
which grow in the human intestine are numerous. 
It is probable, however, that butcher's meat, fish, 
oysters and other shellfish are the chief sources, for 
Tissier found that when he obtained flesh from 
the slaughterhouse in as fresh a condition as pos- 
sible, it contained all the bacteria necessary to pro- 
duce active putrefaction, which was made evident 
to the sense of smell within twenty-four hours, and 
became more and more pronounced from day to 
day. 

Bacteriologists have shown that the mouth al- 
ways contains putrefactive bacteria. The normal 
stomach is sterile during digestion, because the gas- 
tric juice is a powerful germicide and destroys 



186 COLON HYGIENE 

them ; but in stomachs which do not produce a suffi- 
cient amount of gastric juice, and in normal 
stomachs when empty of food, great numbers of 
these dangerous microbes may be found. 

Below the stomach the number of bacteria in- 
crease. At the lower end of the small intestine, 
and in the caecum, the number of living bacteria 
is the greatest. 

The reason for this is the presence of food resi- 
dues and body wastes of character suitable to en- 
courage the growth of putrefactive bacteria, while 
starch and sugar which are needed for the growth 
of acid-forming organisms are absent, having been 
digested and absorbed in the small intestine. 

Changing the Intestinal Flora 

Many people seek by change of climate, often 
at great expense and inconvenience, to secure re- 
lief from ailments which only require a change of 
the character of the bacteria growing in their in- 
testines and are to no appreciable extent affected 
by the climatic influences. If sometimes relief is 
found by such persons in a change of climate it is 
because an incidental change of their intestinal 
bacterial growth happens to occur at the same 
time. "Bilious" climates do not exist. "Bilious- 
ness," an unscientific but significant and useful 
word, signifies conditions that can be remedied 
only by in some way getting rid of putrefactive 



DISCUSSION OF ALIMENTARY TOXEMIA 187 

bacteria and putrefaction processes that are active 
in the intestines. 

Dr. Tissier, of the Pasteur Institute, was the 
first to point the way to methods of changing the 
flora of the intestine. His plan was to displace 
"wild," noxious, poison-forming bacteria which have 
taken possession of most adult intestines through 
wrong habits of life, especially in diet, by harm- 
less, acid-forming species, such as Nature plants 
in the intestines of the young infant within a few 
days after birth. 

There are various ways in which the intestinal 
flora may be changed. Three things are essential: 

1. The diet must be such as to encourage the 
growth of friendly germs, the acid-formers, and 
discourage the growth of unfriendly and unde- 
sirable ones, the poison-formers. This requires a 
fleshless diet and in some cases a diet free from 
animal protein, that is, a diet which excludes eggs 
and milk as well as meats of all kinds. 

2. The bowels must be made to move three 
times a day or more frequently so as to hasten the 
displacement of the undesirable bacteria and to 
dislodge them from their hiding places. 

3. The introduction of friendly, acid-forming 
bacteria in such large numbers as to enable them 
to take possession of the intestine and establish 
themselves in the colon where their services in 
combating putrefactive processes is needed. 

The change of diet may be effected by adopting 



188 COLON HYGIENE 

the "milk regimen" for a limited period. The "fruit 
regimen" — fresh fruit and such green vegetables as 
lettuce, celery, and cucumbers answers the same 
purpose. The " whey cure," " kumyss cure," and 
"milk cure" are other dietetic methods of changing 
the flora. 

Fasting will not change the flora for reasons 
given elsewhere, (see pages 103-106). 

In general, the antitoxic diet elsewhere described 
(see pages 221-240) is the most practical solution of 
the diet problem in relation to bacterial change in 
the intestine. In cases in which it is desirable to 
secure a gain in flesh in connection with a change 
of the intestinal flora, a milk diet may be success- 
fully employed. 

The "Milk Regimen" 

Cow's milk is not a natural food for grown-ups, 
either human or bovine. Milk is deficient in iron, 
and contains an excess of protein, and lime. Cow's 
milk disagrees with many persons, children as well 
as adults. It is certainly by no means an ideal 
food. Yet many persons are benefited by its tem- 
porary use when proper precautions are taken. 
The first essential is that the milk shall be taken 
in large amount, so large as greatly to exceed the 
needs of the body, and thus fill the alimentary 
canal with material which will promote the growth 
of friendly bacteria, or sour milk germs, for which 
milk supplies the very best medium. 



DISCUSSION OF ALIMENTARY TOXEMIA 189 

A second essential is that the milk shall be 
taken often. A half pint every half hour or every 
forty minutes is the usual plan. This is necessary 
to make it possible to take into the stomach the 
five or six quarts of fluid required for one day's 
milk ration. It is also important to maintain a 
constant stream of fresh material passing along the 
alimentary canal, so that a considerable portion 
may reach the colon undigested and unabsorbed. It 
is especially important that a sufficient amount 
of milk sugar should reach the colon unabsorbed 
to maintain in the colon a state of acid fermenta- 
tion thereby preventing putrefaction and changing 
the intestinal flora. This is, indeed, in many cases, 
the chief benefit derived from the milk diet. To 
encourage this change it is well to give at each al- 
ternate feeding yogurt buttermilk in place of 
sweet milk; or equal parts of sweet milk and milk 
soured by the Bulgarian ferment may be taken at 
each feeding. 

Feeding begins at 7:00 a. m. and ends at 7:00 
p. m. — twenty-five feedings in all. At 10:00 a. 
m. and 4:00 p. m. the milk is omitted and a meal 
of fruit is taken instead. The purpose of this is 
to encourage bowel activity, since very free and 
frequent bowel movement is essential to success. 
The disappointing results often encountered in the 
use of the milk diet are chiefly due to the constipa- 
tion which is likely to be produced in many persons, 
the natural result of which is intestinal toxemia 



190 COLON HYGIENE 

and an aggravation of the very symptoms relief 
from which is sought. 

An ounce of wheat bran or agar-agar should be 
taken daily in half ounce doses, preferably at 8:00, 
10:00, 12:00, and 4:00 o'clock feedings. In cases 
in which the colon is badly crippled, the use of 
the Russian paraffin oil in doses of one tablespoon- 
ful three or four times a day is necessary to secure 
the active bowels required for a rapid and efficient 
change of the flora. 

When the period of exclusive milk feeding is 
ended, the milk should be at once discarded and a 
strict antitoxic diet adopted ; milk, meat, fish, fowl, 
eggs and all kinds of animal protein must be dis- 
carded. Milk is unwholesome for most invalids and 
often even in very small amounts. This is especially 
true of persons suffering from colitis. It is most 
likely to produce unpleasant effects when taken 
in small amounts with other foods. It is generally 
tolerated when taken as an exclusive diet and in 
large amount because of the special conditions estab- 
lished whereby a change of the intestinal flora is 
accomplished. 

It should be remembered that the chief advantage 
of the milk diet as a means of changing the intesti- 
nal flora lie — (1) in the large amount of milk sugar 
which by this means is carried into the colon and 
there, fermenting, produces lactic acid and so pre- 
vents the growth of the putrefactive bacteria; (2) 
in the frequent bowel actions induced by the large 



DISCUSSION OF ALIMENTARY TOXEMIA 191 

surplus of food ingested. The soft curds, undigested 
and unabsorbed by their bulk as well as by their 
acidity stimulate peristalsis to such a degree as to 
cause several bowel movements daily. In certain 
cases, however, in which mechanical obstacles to 
bowel action exist, such as either spasm or incom- 
petency of the ileocecal valve, or adhesions of the 
pelvic colon, constipation may continue in spite of the 
largest quantities of milk that can be taken. In such 
cases the sugar of milk is wholly absorbed, leaving 
the curds to putrefy in the lower colon, and the most 
intense toxemia may result. The writer has met a 
number of cases of this sort. This is the cause of 
the disastrous failure of the "milk cure" in certain 
cases. 

The "Fruit Regimen" 

To meet the needs of certain patients who have 
an idiosyncrasy against milk, especially cases of 
colitis, the writer has conducted a large number of 
experiments for the purpose of discovering a diet 
for changing the intestinal flora suitable for general 
use and especially in cases in which milk is not 
tolerated. The result of many experiments was the 
selection of a diet consisting chiefly of wheat bran 
and fruit; lettuce, cucumbers, tomatoes and any 
other uncooked product of the garden may be added, 
but the chief part of the diet must be bran and 
fruit. Such a dietary practically eliminates protein 
and fats. Food may be taken either three or four 



192 COLON HYGIENE 

times a day. Two or three tablespoonfuls of ster- 
ilized wheat bran should be taken at each meal. 
A convenient way to take the bran is in the form 
of a soup or porridge made with stewed toma- 
toes or some fruit. A spoonful of oatmeal or corn- 
meal may be added if desired. 

All sorts of fruit may be eaten freely. Dates are 
especially valuable because of the sugar which they 
contain. 

In addition, a paraffin tablet or a tablespoonful of 
white Russian paraffin oil should be taken at each 
meal. 

The result will be three or four free bowel move- 
ments daily, and at the end of three or four days 
the stools will become odorless or nearly so. A slight 
acidity is a good indication, showing that the flora is 
completely changed, the putrefactive and poison- 
forming germs having been displaced by the benefi- 
cent acid-formers. 

After the flora has been thus changed by a bran 
and fruit diet closely adhered to for a few days v 
a careful antitoxic diet should be closely followed as 
a permanent regimen. It is a great error to suppose 
that the intestinal flora can be definitely and perma- 
nently changed by a brief course of treatment or 
by any plan which does not include the complete and 
permanent exclusion of "toxic" foods. Meats of all 
sorts must be wholly discarded. Eggs must be used 
sparingly if at all. In not a few cases milk must 
be carefully avoided even as an ingredient of 



DISCUSSION OF ALIMENTARY TOXEMIA 193 

soups and other dishes. Some persons may recoil at 
the idea of so great a limitation of the dietary; but 
a person who has suffered from such distressing 
effects of chronic intestinal toxemia as a severe ec- 
zema, frequent "sick headaches," Bright's disease or 
arteriosclerosis will be quite willing to undergo al- 
most any sort or degree of gustatory discipline if 
assured that the sacrifice will secure the desired 
result. Fortunately, this assurance may usually be 
given with the greatest confidence that the results 
will not be disappointing. 

The free use of bran and paraffin must be con- 
tinued indefinitely, and care must be taken not to 
omit their use at a single meal. If thorough evac- 
uation of the bowels does not occur three or four 
times daily the amount of paraffin or quantity of 
bran, or both, should be increased. Agar-agar in 
some form may be used in place of bran, or in con- 
nection with it. There need be no fear of injuring 
the intestine by producing irritation. The writer 
does not hesitate to make this statement after hav- 
ing carefully watched the effects of the measures 
above recommended in hundreds of cases. If the 
measures suggested are employed with sufficient 
thoroughness, and continued for a sufficient length 
of time, the effort will not fail of success. It is nec- 
essary in many cases, to supplement the regimen 
recommended by means of treatment which will 
thoroughly cleanse the colon, introduce a normal 
flora, and reform the wild bacteria with which the 



194 COLON HYGIENE 

colon is infected. For a detailed description of 
these measures the reader is referred to the direc- 
tions given elsewhere in this work for the treatment 
of colitis. (See page 330). If an ammoniacal or 
putrescent odor appears in the feces at any time the 
fruit regimen must be resumed for a few days un- 
til the odor disappears. The diet should be care- 
fully studied and modified as necessary until the 
stools become regular, frequent, and practically free 
from odor, or at least free from putrescence. 



Forms of Constipation 
Classification 

Constipation, although a symptom rather than 
a disease, itself becomes a cause of various and often 
most serious vital disturbances. Every bodily func- 
tion and every structure may suffer damage through 
the failure of the body to be relieved of the highly 
poisonous refuse which it is the duty of the colon to 
discharge. 

The symptoms by which the presence of consti- 
pation may be known differ according to the form 
of constipation which is present. Although many 
different forms of constipation have been described, 
practically all phases of this disorder may be in- 
cluded under three heads, namely: 

1. Simple constipation. 

2. Cumulative constipation. 

3. Latent constipation. 

The Symptoms of Simple Constipation 

When fecal matters remain in the intestines 
more than twenty-four hours, constipation exists. 
Some authorities place the limit at forty-eight hours, 
while others assert that every individual is a law 
unto himself, and that a bowel movement once in 
two or three days is as normal for some persons as a 
daily or twice-daily movement is for others. The 

195 



196 COLON HYGIENE 

writer feels certain that these authorities are in error. 
Their conclusions have been drawn from observa- 
tions made upon unhealthy rather than normal 
individuals. For reasons stated elsewhere in this 
work, the writer is fully persuaded that the normal 
rhythm of the intestine is a movement after each 
meal, or at least after each full meal. Certainly, 
when the bowels do not move regularly at least 
once a day, constipation may be said to exist. 

In simple constipation the evacuation of the 
bowel content is not complete. A normal desire 
for evacuation occurs when the feces enter the 
rectum, but normal bowel movements occur only 
every other day, or perhaps at somewhat longer in- 
tervals, or at irregular periods. There is simply a 
slowing of the rate at which the food moves along 
the alimentary canal, due to some one or more of the 
many causes which have been mentioned in the pre- 
ceding pages; but there is no disturbance of the 
defecating mechanism. 

Most cases of chronic constipation begin with 
the simple form. The cause is most commonly a 
concentrated diet, irregular meals, sedentary habits, 
or neglect to attend promptly to the "call" for 
evacuation of the bowels. 

Symptoms of Cumulative Constipation 

In cumulative constipation, which is perhaps the 
most common form, the difficulty is almost wholly 



FORMS OF CONSTIPATION 197 

confined to the lower part of the colon. Cumu- 
lative constipation is for the most part a disorder 
of the defecating mechanism. The food and the 
feces move along the small intestine and the upper 
part of the large intestine at the proper rate; but 
after the feces have reached the pelvic colon, they 
are retained either in the colon itself or in the rec- 
tum, instead of being promptly discharged. The 
special characteristics of cumulative constipation are 
dry hard stools, loss of the rectal reflex, caused by 
the retention of fecal matters in the rectum and 
distension of the rectal walls, and in pronounced 
cases, complete loss of the "call" for evacuation of 
the bowels. In cumulative constipation, the diffi- 
culty exists in the lower half of the colon, or be- 
low the splenic flexure. 

In well pronounced cases of cumulative consti- 
pation, a considerable quantity of feces will always 
be found present in the rectum, although in a cer- 
tain number of cases the accumulation occurs only 
in the pelvic colon. The latter cases are sometimes 
the most difficult of relief, because of the existence 
of obstruction at the pelvi-rectal valve, or of ad- 
hesions of the pelvic loop to the floor of the pelvis. 
Sometimes the pelvic colon has become so large by 
overstretching that, when filled, it is so heavy that 
it cannot rise, but becomes impacted in the hollow 
of the sacrum, folded upon itself and incapable of 
emptying itself. In such cases, as in most cases of 
cumulative constipation, bowel movements occur 



)9Q COLON HYGIENE 

only as the result of pressure from accumulation 
of feces in the colon, a process which necessarily 
involves great distension of the colon and resulting 
injury to its walls, and to the ileocecal valve, which 
is often rendered by this means wholly incompetent. 
When in cases of cumulative constipation the 
bowels are made to move by violent straining ef- 
forts, the rectum is not emptied. A few masses of 
hard, dry feces, sometimes a single mass covered 
with mucous, may be extruded, but a thorough 
emptying of the bowel never occurs. In cases in 
which the rectum only has lost its sensibility, the 
sense of weight and pressure often lead the patient 
to make repeated efforts during the day to relieve 
the bowels, with the result of securing perhaps each 
time a small movement. This has been termed 
''fragmentary constipation" by Boas, the eminent 
Berlin specialist, but it is only a form of cumulative 
constipation. 

Symptoms of Latent Constipation 

In latent constipation the bowels move regularly, 
or at least daily. In most cases the patient has no 
idea that he is suffering from constipation. An ex- 
amination, however, by means of suitable tests 
shows that there is delay at one or more points along 
the food tube. There is no disturbance of the 
mechanism of defecation. The "call" for bowel 
movement occurs, and often with inconvenient fre- 



FORMS OF CONSTIPATION 199 

quency, and the lower colon is emptied of its con- 
tents. There is no accumulation of feces in the 
rectum, but if a portion of charcoal or carmine is 
given with a meal, forty-eight hours or even a longer 
time may elapse before the colored matter makes its 
appearance, and a longer time before it is all dis- 
charged. 

The exact point at which the delay occurs 
may ' be ascertained by administering a bismuth 
test meal and watching its progress along the food 
tube by the aid of a powerful X-ray apparatus. An 
examination of this sort is highly important in 
cases of latent constipation, affording the only means 
by which the real nature and location of the dis- 
turbance can be ascertained. 

The feces in latent constipation are generally 
very dark in color, ragged and foul smelling, the 
result of the advanced putrefaction induced by their 
long retention. 

The reflex contraction of the ileocecal valve pro- 
duced by the pain of chronic appendicitis and other 
painful affections of the pelvis and lower abdomen, 
may be the cause of latent constipation, which, 
when due to this cause, is sometimes called "reflex" 
constipation, for the reason that it is generally re- 
lieved by measures which lessen the activities of the 
sympathetic nerve and so relax the ileocecal sphinc- 
ter. Latent constipation is also very commonly 
associated with colitis, on account of the spastic con- 
dition of the intestine often present in this disease, 



200 COLON HYGIENE 

which may be a consequence as well as a cause 
of latent constipation. 

Incompetency of the ileocecal valve is probably a 
very frequent cause of latent constipation. 

A marked symptom of latent constipation when 
associated with incompetency of the ileocecal valve is 
the great amount of intestinal gas from which it is 
impossible to get entire relief. This is due to the 
fact that the gas generated in the colon escapes into 
the small intestine and cannot be wholly expelled 
because the colon discharged its contents internally, 
into the small intestine, as well as externally. 

Mixed Forms of Constipation 

The majority of cases of constipation may be 
clearly assigned to one of the above-defined classes. 
Not infrequently, however, cases are encountered 
which present most of the symptoms of the several 
classes of constipation. Colitis with spastic con- 
stipation is often observed in cases in which there is 
also a failure of the defecating mechanism to per- 
form its work properly, and cumulative constipation. 



The Treatment of Constipation 

Hygiene 

The first point of importance in the treatment 
of constipation is hygiene. A person must by every 
means in his power endeavor to improve his general 
health. Chronic ill health always involves, either 
primarily or secondarily, a lowering of the vital 
status, and is in most cases not a result of a single 
error in habits of life, but of numerous infractions 
of the rules of healthy or biologic living. So many 
different factors are involved in the function of 
bowel movements, that it is highly essential that a 
person w^ho is suffering from chronic constipation 
should seek by every available means to improve 
his general health, and thus increase the vigor of all 
his bodily functions. 

If one's habits have been sedentary, he must make 
a radical change in his mode of life. When possible, 
a change from an indoor employment to an active 
occupation out-of-doors is most desirable. This in 
itself will in many cases be found quite sufficient 
to secure regular bowel movements. 

If the circumstances of life have been such as to 
give rise to worry or nervous depression, some 
change should be effected by which the causes of 
irritation and depression may be gotten rid of, or 
the individual should, by the cultivation of optim- 

201 



202 COLON HYGIENE 

ism, endeavor to rise above the influence of his 
surroundings. 

Constipation is in most cases simply one of the 
unhappy results of the artificial conditions imposed 
upon us by modern civilized life. The only escape 
from this terrible handicap of all useful human 
activities is to be found in a rational return to 
Nature, in the adoption, so far as is necessary to 
secure the physiological conditions, of natural and 
primitive habits, particularly in reference to diet, 
sleep, exercise, and out-of-door life. 

Before proceeding further the reader who is 
making a serious study of this subject is asked to 
re-read carefully two of the preceding chapters, 
entitled, "Influences Which Normally Excite the 
Movements of the Colon" and "Influences Which 
Discourage or Lessen Intestinal Movements," bear- 
ing always in mind the fact that for the successful 
treatment of constipation every possible factor which 
aids bowel activity must be utilized, and that every 
factor which has a discouraging influence must 
be most carefully avoided. 

General Habits 

Many of the causes of constipation, and many 
of the influences connected with every-day life which 
tend to produce this condition, have been already 
discussed with some detail, and need not be recon- 
sidered here. The bearing of each one of these 



TREATMENT OF CONSTIPATION 203 

causes should be considered in each individual case, 
and not one unfavorable influence should be per- 
mitted to remain. 

Clothing 

This has a very much more direct bearing upon 
the functions of the colon than might at first be 
supposed. Corsets and belts, as has already betn 
shown, tend directly to produce constipation by 
hampering the movements of the diaphragm, pre- 
venting proper development and activity of the 
abdominal muscles, and causing displacement of 
the colon and other viscera into the lower portion 
of the abdomen. Excess of clothing tends in the 
same direction by overheating the body and pro- 
ducing excessive perspiration and relaxation of the 
muscular structures of the abdomen, and perhaps 
also of the intestines. 

Finally, as regards hygiene, every person who 
is suffering from constipation and really desires to 
be delivered from the miseries attendant upon this 
condition should be careful to avoid all habits and 
influences which tend to retard or discourage bowel 
action and will most assiduously cultivate every 
influence and habit which tends to encourage in- 
testinal activity. 

Constipation Always Curable 

Every person who undertakes to combat con- 
stipation should know at the start that his efforts if 



204 COLON HYGIENE 

thoroughgoing and persistent may be expected to 
win. There are many thousands of sufferers who 
have become utterly discouraged through unsuccess- 
ful efforts and have become convinced that the 
malady is incurable, and that nothing more can 
be done than to mitigate the evils of the malady as 
much as possible by laxative drugs and the use of the 
enema, withstanding their well-known evil effects. 
There are many thousands of others who depend 
wholly upon the use of laxative drugs or mineral 
waters for bowel movements and who are unaware 
of the harmful effects which inevitably result from 
the long continued use of drugs which force bowel 
movement by creating an artificial irritation. The 
majority of such persons are always looking for 
some new laxative drug to take the place of one 
which has lost its effects, fully believing that there 
is no other way of doing. There is apparently a 
widespread belief that constipation is incurable. 
This hopeless view, quite generally held by physi- 
cians as well as the laity, is the very natural result 
of the wrong methods which are generally employed, 
and the great ignorance concerning the intimate 
nature and causes of constipation. This ignorance 
has been quite excusable, however, because of the 
lack of scientific knowledge respecting the physi- 
ology of bowel action. But now that the light of 
new discovery has illuminated this dark corner of 
human physiology, the treatment of constipation is 
no longer necessarily a hopeless groping in the 



TREATMENT OF CONSTIPATION 205 

dark but may be made a regular organized cam- 
paign against an enemy whose nature and favorite 
haunts are known and against which recent medical 
science has provided efficient weapons. 

And a veritable campaign the effort must be if 
success is to be attained in really grave cases. But 
victory may be attained in every case. It must be 
understood, however, that there is no panacea for 
constipation. There is no one simple means by 
which all cases may be cured, and some cases require 
the simultaneous employment of almost every known 
rational remedy. A very few cases require the 
aid of surgery; and even surgery seldom succeeds 
when made the sole reliance. Fortunately surgery 
is very rarely needed when all other means are ef- 
ficiently used. 

What Is a Cure of Constipation? 

When a child has measles or scarlatina or when 
a person suffers an attack of typhoid fever, the 
usual result under modern management is such a 
recovery that no traces of the disease or its effects 
are discoverable. The individual is apparently as 
well in every respect as before the illness. Mod- 
ern medical research has taught us, however, that 
this completeness in recovery is more apparent than 
real. Besides the permanent injuries to eyes and 
ears, which are often left after measles and scarlet 
fever, there are not infrequently far more serious 



206 COLON HYGIENE 

injuries to heart, lungs, or kidneys. And statistics 
show that whenever typhoid fever and small-pox 
are prevalent, pulmonary tuberculosis increases. 
Thus we know that recovery does not really mean, 
even in acute disease, absolutely complete restora- 
tion to former soundness. 

In chronic disease this is still more evident. An 
attack of acute disease is like a sudden outburst of 
flame in a dwelling from the upsetting of a lamp or 
from some similar accident. The fire is usually 
quickly extinguished and the house itself is little 
injured. A chronic malady is often like a fire 
which has begun in the basement of the house and 
has gradually worked its way up in the inner 
walls until it has reached the top and burst out in 
flame through the roof. Acute disease we may 
say is analagous to a fire in a house while chronic 
disease is a fire of a house. In lung tuberculosis 
a cure means an arrest of the disease process and a 
healing of ulcerated surfaces in the lung; but lung 
tissue which has been destroyed is not restored ; and 
the consumptive who has been cured by the out- 
of-door life and other means must continue to em- 
ploy the essentials of the curative treatment in 
order to keep well. No consumptive can expect to 
remain well if he returns to the old conditions of 
life under which he became ill. He must make a 
radical change in his habits of life and the change 
must be permanent. In case of an injury to a leg, 
the patient may recover, but with the loss of a leg. 



TREATMENT OF CONSTIPATION 207 

By the aid of an artificial leg he will be able to walk 
very well, but not so well as with a natural limb. 

The situation is exactly the same in constipa- 
tion. In very chronic cases, much irreparable dam- 
age has been done. The colon has been perma- 
nently crippled. The art of treatment is to find 
out the exact nature of the injury and to find means 
for supplying the needed aid, much as an artificial 
leg in a large measure supplies the place of a missing 
limb. These measures must be such as render 
aid in a physiologic way, and must be harmless in 
character. When once the necessary means have 
been found and adapted to the individual case they 
must be perseveringly employed not for a few 
days or weeks or months; their use must become a 
life habit. In general it is possible to secure a 
considerable degree of improvement so that a few 
and simple means will afford all the aid required 
though at first the concerted use of many measures 
was required. 

If, for example, it is found that the addition to 
the food of a liberal quantity of sterilized wheat 
bran will secure three normal bowel movements 
daily, this simple means must be faithfully used, 
not only daily, but at every meal. If it is found 
that the bowels are ready for evacuation at a certain 
hour, a natural "call" being experienced at that- 
time, this hour must be religiously set aside for this 
duty. Nothing may be allowed to interfere with 
this duty. Whatever plan or program is found to 



208 COLON HYGIENE 

secure efficient bowel action, this program must be 
carried out every day with greatest circumspection. 
Nature must not be discouraged or thwarted in her 
efforts. Every pains must be taken to foster every 
symptom of returning normality in bowel functions. 
When a "call" occurs, it must be answered at once. 
The delay of a few minutes only may extinguish the 
effort Nature is making to reestablish the normal 
rhythm. It takes considerable will and character to 
conquer constipation as well as knowledge and per- 
severance. But the gain in clearness of mind, zest 
for work, endurance of mind and body, and 
general efficiency, to say nothing of such 
gains as keenness of appetite, sweetness of breath, 
clearness of skin, sound sleep and sense of joy in 
being alive, are ample compensation for the effort 
required. If it is a life-long battle to conquer 
constipation, it may be a winning battle and one 
which lengthens one's days and wonderfully in- 
creases capacity for useful activity and enjoyment 
of life. 

When Is Surgery Needed? 

It will not be possible to review in a brief para- 
graph the various opinions which have been ex- 
pressed by eminent medical authorities respecting the 
indications for surgical relief in cases of obstinate 
constipation, nor to offer the reasons for or against 
the various surgical procedures which have been 



TREATMENT OF CONSTIPATION 209 

proposed. It must suffice simply to enumerate the 
principal conditions concerning which the concensus 
of authoritative surgical opinion is settled and 
clearly defined. 

Constipation due to organic obstruction resulting 
from tuberculosis, cancer, or other morbid growths, 
necessarily requires surgical interference, and an 
abdominal surgeon should be consulted at once, 
one experienced in intestinal surgery. This is 
important, for in surgery of this character results 
depend almost wholly upon exactness and perfection 
of technic, such as can be gained only by long and 
extensive practice. 

Chronic as well as acute appendicitis is an indi- 
cation which may open the way for relief of con- 
stipation by removal of an active cause. This is 
especially true in cases in which an X-ray examina- 
tion shows many adhesions about the inflamed ap- 
pendix, which fix the cecum so that it cannot empty 
itself or perhaps cause obstruction of the lower end 
of the small intestine. The necessity for opera- 
tion may exist in cases of this sort, even when 
little pain is felt in the region of the appendix. Not 
every case in which such adhesions exist, however, 
requires operation. By far the great majority may 
be substantially relieved by non-surgical measures. 

Adhesions of the ascending or descending colon, 
and especially adhesions which compress the pelvic 
colon and limit its movements, may be relieved by 
appropriate surgical procedures when other means 



210 COLON HYGIENE 

fail. These cases seldom require removal of the 
colon or any portion of it, or even the so-called 
short-circuiting operation which often affords only 
temporary relief unless care is taken to restore the 
ileocecal check valve. When adhesions of the pelvic 
colon are broken up the pelvic loop must be sus- 
pended in such a way as to prevent the reproduc- 
tion of the restricting adhesions which will almost 
certainly occur unless some efficient means of pre- 
vention is adopted. 

A very definite indication for operation in cer- 
tain cases in which other n ~ans fail is incompetency 
of the ileocecal valve accompanied by very pro- 
nounced stasis or stagnation in the small intestine. 
This condition is sometimes accompanied by the 
most incorrigible constipation and by most pro- 
nounced intestinal toxemia as shown by enormous 
quantities of indican and other putrefactive products 
in the urine and by intractable headaches. An 
operation has within a few years been devised by 
which the incompetent valve may be repaired so 
as to effect a radical cure of the incompetency of 
the valve and, fortunately without any considerable 
degree of risk. This operation has been now per- 
formed in a sufficient number of cases to demon- 
strate its value in cases which do not yield to other 
measures. 

Diverticulitis (see page 348) sometimes requires 
operation but probably much less often than has 
been thought if thorough-going non-surgical meas- 



TREATMENT OF CONSTIPATION 211 

ures of treatment are instituted. Anal hemorrhoids, 
fissures, fistula, spasm due to local irritation, recto- 
cele in women and prolapse of the rectum are other 
measures which may be readily cured by surgical 
procedures which are not attended by risk nor 
even, when skillfully done, by much pain or incon- 
venience. 

Regularity of Meals Necessary 

The bowels do not move without a reason for 
moving. The pelvic colon is an ejecting apparatus 
for expelling fecal residues, which works only when 
brought into action by the reflex nervous mechanism 
which comprises the nerves of the rectum, the de- 
fecating center, and the connecting nerve trunks. 
The entrance of food into the rectum is like the 
closing of a switch which controls the starting and 
stopping of a motor. When the rectum is distend- 
ed, the nerves are stimulated, and in turn excite the 
defecating center where they originate. From this 
center are sent out impulses which cause the pelvic 
colon to contract strongly and empty itself. In 
doing this it is assisted by strong contractions of the 
abdominal muscles and of the rest of the colon. 

This process, it must be remembered, is set in 
operation only when there is a sufficient movement 
of feces from the pelvic colon, where the feces are 
stored, into the rectum, to produce the necessary 
amount of stimulation. As we have already seen, 
this is accomplished, normally, by peristaltic move- 



212 COLON HYGIENE 

merits set up by taking into the stomach relishable 
food. In constipation, these stimulating reflexes 
are often weak, and must be reinforced by every 
means possible. Hence the diet must be so managed 
as to secure the maximum amount of stimulating 
influence upon the lower bowel. Eternal vigilance 
is necessary; every meal must be taken with refer- 
ence to the bowel action. A single omission of a 
meal, or a meal of unsuitable food, may be sufficient 
to produce an undue accumulation of feces in the 
colon and rectum, and unless this is immediately 
corrected, the most serious results may follow. The 
taking of food, then, serves a double purpose, it 
supplies the body with needed nourishment and at 
the same time furnishes the impulse needed to enable 
the body to get rid of the unusable residues of a 
previous meal and of a portion of its constantly 
accumulating intestinal excretions. So if regularity 
of bowel movement is to be expected, care to take 
the food at regular intervals becomes a matter of 
absolute importance. With the savage, regularity 
of bowel movement is not a matter of so great 
importance, for the reason that he is rarely so situ- 
ated that he cannot respond quickly to the "call" for 
evacuation. But civilized human beings by their 
systematic and, in general, their closely occupied 
life, must often find themselves in circumstances 
which compel a considerable delay in answering 
the "call" without being seriously incommoded. 
Rather than interrupt the normal rhythm, even on 



TREATMENT OF CONSTIPATION 213 

a single occasion, it would be better to incur a very 
considerable degree of inconvenience, a fact which 
the constipated must take to heart and carry in 
mind; but it is better to observe such an order of 
life and such regularity of habits as will cause the 
bowels to move at a time at which they may without 
haste or inconvenience receive the leisurely and 
thorough attention which the importance of this 
function demands. 

Every meal must contain foods which will leave 
a sufficient amount of residue to prevent stagnation. 
To neglect this fact on a single occasion may in the 
case of a constipated person, who by careful atten- 
tion to regimen has established regular bowel habits, 
cause the beginning of a return of all the old con- 
ditions. 

Too much emphasis cannot be laid upon the 
absolute and unfailing faithfulness required to main- 
tain the improved condition which may have been 
attained. The majority of cases of constipation 
relapse sooner or later, but chiefly because patients 
return to their old irregular and careless habits. 
Drugs are resorted to because by their use the 
difficulty is temporarily overcome with so much less 
trouble and self-control than is needed for the com- 
plete regulation of one's habits of life, especially 
in relation to eating. Sufficient care in the matter 
of diet will be followed by success in nearly all 
cases of simple constipation. It is necessary, how- 
ever, that the proper regimen should be strictly and 
uninterruptedly followed. 



214 COLON HYGIENE 

Supplementary Bowel Movements 

The act of defecation must be made as complete 
as possible. The rectum and lower bowel are often 
filled with dry feces which are an obstacle, the 
removal of which by patient and continued effort 
may be followed by a full and natural movement. 

Sometimes a partial movement will be followed 
by another, within a half hour or less. Many 
persons evacuate their bowels in the morning by 
two movements, one on rising and the other soon 
after breakfast. Whatever may be the vagaries of 
the individual colon, if it can be persuaded to act 
at all, other things must be accommodated to its 
needs. In many cases, always when the movemenf: 
seems less complete than usual, it is wise to give 
the bowels a second opportunity for movement a few- 
minutes or half hour later. If a second "call" is 
experienced, the matter should not be ignored, but 
should receive instant attention. The moving of the 
bowels is a matter of equal importance with the 
taking of meals, and should be given the same con- 
sideration. A crippled colon must be humored and 
coddled, so to speak, and in many cases apparently 
hopeless the result may be in time that the colon 
may be trained back to habits of normal activity 
and regularity. 

Sleep 

The important relation of sleep to constipation is 
shown by the fact that loss of sleep, or a change of 



TREATMENT OF CONSTIPATION 215 

sleeping hours from night to day, very quickly upsets 
the bowel rhythm when it is nicely balanced in a 
person of sedentary habits. Cannon showed that 
the bowel contents advance very slowly during 
sleep, but very rapidly during and directly after 
eating. Evidently sleeping after eating must tend 
to constipation by interfering with the normal ad- 
vance of the colon contents toward the exit. 

Loss of sleep does not, however, increase bowel 
activity, but rather has an opposite effect, doubtless 
because of its general depressing effects. This is 
shown in the lack of appetite and in the coating of 
the tongue which result from loss of sleep. Relish 
for food is one of the normal stimuli of the intes- 
tines. 

Posture During Sleep 

This is by no means a matter of no importance. 
Gravity exerts a decided influence upon the con- 
tents of the stomach and intestines in states of 
disease, although the influence of this force is of little 
moment in conditions of health. In health the food 
is grasped by the digestive tube as soon as it reaches 
the back of the throat, and this vital grip is main- 
tained until the residue of the food is cast out at 
the anus. 

In disease, the situation may be greatly changed. 
The walls of the stomach, instead of contracting 
upon the food and kneading it, are relaxed and hang 



216 COLON HYGIENE 

loosely separated like the sides of a bag. The 
stomach no longer grips the food, and so gravitation 
controls it to a large degree. Under these circum- 
stances it is best for the patient to lie upon the 
right side in case a meal has been eaten within two 
or three hours before going to bed, or if there is 
evidence of the presence of food or liquid in the 
stomach on retiring. 

When the cecum is known to be dilated and the 
seat of stagnation, it is well to sleep upon the left 
side, so as to facilitate the movement of food along 
the relaxed colon. 

In cases in which the abdominal muscles are 
much relaxed and the whole colon dilated, so that 
intra-abdominal pressure is much reduced, it is well 
to lie upon the face, so that the weight of the body 
may by constant pressure upon the abdominal con- 
tents aid the progress of the feces along the crippled 
colon. Thin persons may often adopt with advan- 
tage the practice of sleeping on the face with a 
pillow beneath the abdomen. Backache, and various 
discomforts in the abdomen, especially in cases of 
colitis, may be relieved by this simple procedure. 
Persons whose stomach and intestines are much re- 
laxed and sluggish in consequence are much bene- 
fited by lying upon the face for half an hour or an 
hour after each meal. This not only aids the pas- 
sage of liquids from the stomach, but helps the 
colon, and prevents the excessive congestion of the 
viscera, which naturally results from the excitement 



TREATMENT OF CONSTIPATION 217 

of digestion when the intra-abdominal pressure is 
very low. The nervousness from which many dys- 
peptic and constipated persons suffer after eating 
may be relieved and prevented by half an hour's 
rest lying upon the face after meals. It should be 
observed that it is not well to sleep at this time. 



Diet in Constipation 

The writer once asked a celebrated Vienna pro- 
fessor, "What do you do for constipation ?" The 
reply was, simply, "Diet." "But, professor, what 
do you do for cases in which diet and all other 
means have failed?" The reply was still, "Diet, 
only diet." 

Proper regulation of diet is certainly the most 
important of all measures to be adopted in the 
treatment of constipation although there are other 
measures which are too valuable to be neglected. 
A practical cure may in many cases be effected by 
this means alone, provided, of course, that proper 
attention is given to ordinary bowel hygiene. No 
attempt should ever be made to treat a case of con- 
stipation without proper regulation of diet. Such 
a course, no matter how gratifying may be the re- 
sults for the time being, must end in disaster; for a 
physiologic diet is of all things most essential as 
the means of securing normal activity of the intes- 
tines. 

First of all, the fact should be recognized that 
food is Nature's laxative. Natural food taken in 
the proper manner and at proper intervals gives to 
the alimentary canal just the kind and amount of 
stimulation that is required to maintain the normal 
procession of nutrient material along the digestive 
tract, and to effect the prompt discharge of un- 

218 



DIET IN CONSTIPATION 219 

usable residues and poisonous wastes from the body. 
As has been pointed out in preceding chapters, one 
of the effects of eating is to set up in the stomach 
a series of vigorous peristaltic movements, which 
pass from the stomach along the whole length of 
the digestive tube. Under normal conditions 
these movements are sufficient to cause the fecal 
remains of a preceding meal to move down into 
the lower and discharging part of the colon, thus 
setting up the reflex actions which result in their 
discharge from the body. This statement is not 
based upon theory alone, but is founded upon care- 
ful observations by expert roentgenologists, made 
upon the stomach and intestines with the X-ray 
after the administration of the bismuth meal. It 
also agrees with the every-day experience of normal 
persons. The natural time for the bowels to move 
is soon after eating, and under fully natural con- 
ditions a bowel movement occurs after each meal, 
at least, after each principal meal. The writer 
has met a number of persons whose intestines were 
so sensitive to the stimulation of food that the tak- 
ing of food at any time, even in a small quantity, 
had the effect to produce within a few moments a 
desire for evacuation of the bowels. Cases are 
occasionally met in which the taking of food pro- 
duced such strong stimulation that the patient 
found it difficult to finish a meal without interrup- 
tion by the demand of the bowels for evacuation. 
In the dietetic treatment of constipation, it 



220 COLON HYGIENE 

is necessary to understand the particular properties 
of food stuffs to which stimulation of the intestinal 
movements is due, and to make use of these several 
qualities as they may be required in individual 
cases. 

The Laxative Properties of Foods 

The properties of food stuffs to which a laxative 
influence is due may be briefly enumerated as fol- 
lows: 

1. Sapid qualities to which flavor or tastes are 
due. 

2. Bulk, or rather the presence of cellulose, 
which is capable of forming an indigestible residue. 

3. Moisture, that is, a necessary amount of 
liquid taken at meals or between meals, especially 
in connection with cellulose which by absorbing 
water holds it in the intestine. 

4. Chemical properties which result from the 
presence of sugars and organic acids in the food, 
including the sugars formed by the digestion of 
starch, and the lactic acids formed by the fermen- 
tation of sugar in the intestine. Fats are also 
somewhat laxative. 

In the regulation of the diet for the relief of 
constipation, the aim must be to make such selec- 
tion of food stuffs as will furnish these various 
laxative properties in the measure required by the 
individual case. This is by no means a simple 
matter, and requires, first a very thorough know- 



DIET IN CONSTIPATION 221 

ledge of food values and second, a most thorough- 
going investigation of each individual case, so that 
not only the particular form of constipation from 
which he is suffering may be known, whether it 
is simple, cumulative, or latent constipation, but 
also at what point or points in the intestinal track 
the delay occurs, and the cause of the delay. The 
force of this statement will be fully appreciated if 
the chapter on "Causes of Constipation" has been 
read with care. 

Atoxic and Antitoxic Properties of Foods 

In addition to the laxative properties of food 
stuffs, there is another quality of equal importance, 
which must be duly considered in the treatment 
of constipation, because of the prolonged stay of 
undigested food remnants in the alimentray canal 
in constipation, and of the tendency to delay which 
will always remain, even under the best conditions 
which can be supplied. It is of the highest impor- 
tance that the food should be of such a character 
as to prevent as far as possible the putrefactive 
changes which are always increased, and often to 
an extraordinary degree, whenever there is delay. 

Of the' three essential food elements, carbo- 
hydrates (starch, sugars and organic acids), fats, 
and proteins, the last named only is capable of under- 
going putrefaction. Foods rich in starch and su- 
gar do not undergo putrefaction, either outside the 



222 COLON HYGIENE 

body or within the intestine, and hence, are proper- 
ly termed atoxic foods. 

Fats in excess encourage putrefaction, while 
starch and sugar in excess produce the opposite ef- 
fect. By the fermentation of starch and sugar in 
the intestine, acids are formed, which, as has al- 
ready been pointed out, by interfering with the 
growth of putrefactive bacteria, prevent putrefac- 
tion. Fats ferment, when taken to excess, form- 
ing butyric acid, an irritant poison. 

Fruits, starch in vegetables like the potato, and 
green vegetables of all sorts, which contain little 
or almost no protein, together with certain sugars, 
especially milk sugar, maltose or malt sugar, and 
the sugar of fruits, and to a less degree, cereals, 
particularly rice, which are very rich in starch, are 
not only atoxic, being incapable of putrefactive 
changes, but are also highly antitoxic, since they 
in a high degree promote the formation of acids 
in the intestine. 

Antitoxic Value of Uncooked Foods 

A most important point in connection with this 
subject, which appears to have been overlooked by 
writers on dietetics, is the antitoxic value of un- 
cooked foods. Man is the only "cooking animal." 
To the primitive man cookery Was not only un- 
known, but was as unnecessary as for any other 
member of the animal kingdom. The only really 



DIET IN CONSTIPATION 223 

valuable purpose served by cookery is to enable man 
to make use of dried grains and certain coarse 
vegetables, which would otherwise be unavailable 
as food. Experience has proved that food is often 
by cookery deprived of certain elements which are 
essential to human nutrition. The argument made 
by certain faddists who advocate the exclusive use 
of a raw diet, that by cookery the life principle is 
driven out of the food so that its nutritional value 
is lost, has no scientific basis; nevertheless, it is 
true that cookery destroys the life of the cells of 
vegetable foods, and in so doing, deprives the food 
of certain properties which are useful in the in- 
testine. Living cells resist the attacks of the mic- 
robes which produce fermentation and putrefaction. 
A raw apple or potato remains intact for months, 
while a cooked apple or potato is in a few days 
covered with mould, and is in an active state cf 
fermentation and destructive change. Under 
favorable circumstances such changes may take 
place within a few hours, as is seen in the mould- 
ing of bread over night if kept in a warm place. 
In other words, raw food resists the destructive 
changes which are produced by bacteria, while 
cooked food makes no such resistance. 

An experiment made by the writer some years 
ago gave very positive evidence of this fact. Two 
equal portions of cabbage were taken. One por- 
tion was cooked. Both portions were then inocu- 
lated with equal quantities of putrefactive bacteria, 



224 COLON HYGIENE 

by mixing with each a portion of fecal matter. The 
two portions of cabbage were then placed for 
twenty-four hours in an incubator in which the 
temperature of the body was maintained. Exam- 
ination showed that the bacteria in the cooked cab- 
bage had increased enormously in numbers, where- 
as in the uncooked cabbage the number of bacteria 
had not increased, but had actually diminished. 

Many persons have thought themselves benefit- 
ed by the use of raw grains, such as wheat and oat- 
meal. While it would be impossible for a person 
to live on a diet consisting exclusively of raw 
grains, it is possible that some benefit may be de- 
rived from the use of such food to a moderate ex- 
tent, through the fact that uncooked starch digests 
slowly. Cooked starch, as well as sugar and other 
carbohydrates, is normally wholly absorbed in the 
small intestine, or practically so, and therefore 
-furnishes no resistance to the growth of bacteria; 
but raw starch, if taken in more than minute quan- 
tities, as has been shown by experiment by the 
writer, finds its way in considerable quantities into 
the colon. Here, digestion slowly proceeds, pro- 
ducing dextrin and sugar, which furnish to the 
acid-forming bacteria just what they require for 
their growth in a section of the intestine where 
the help of these friendly organisms is most needed. 
Man's natural dietary comprises food containing 
a sufficient amount of raw starch to prevent ex- 
tensive putrefaction in the colon; and therefore 



DIET IN CONSTIPATION 225 

the art of cookery, while essential under the con- 
ditions of modern civilization, is not altogether free 
from disadvantages, which, however, may easily 
be obviated by a proper selection of foods or, in 
special cases, by including in the ordinary bill of 
fare partially cooked foods containing a certain 
portion of uncooked starch, such as oatmeal or 
other grains cooked six to ten minutes. 

Fruits are the most highly antitoxic of all food 
stuffs. They possess in a high degree all the anti- 
toxic properties of food. 

1. They are most acceptable in an uncooked 
state, both to -the palate and to the digestive organs 
They are completely prepared for human sus- 
tenance in the great laboratory of Nature, "cooked 
in the sun," as they say in Mexico. "Cocido en el 
sol?" asked a native fruit seller of the writer, who 
Was seeking to purchase some tropical fruit in the 
market place of a town in Old Mexico. 

2. With very rare exceptions, fruits contain a 
considerable amount of organic acids — citric, malic 
or tartaric, — all of which possess antitoxic proper- 
ties. Even many sweet fruits contain a considerable 
amount of these acids, which are disguised by the 
sugar, but which are not neutralized or destroyed 
by it. 

3. The sugars of fruits promote to a high de- 
gree the growth of acid-forming bacteria in the 
intestine, and thus lead to the formation of lactic 
acid, which, like the acids of fruits, is antitoxic. 



226 COLON HYGIENE 

The antitoxic properties of fruits, though not 
understood until revealed by bacteriological re- 
searches of recent years, have long been utilized 
in a practical way in what is known as the "fruit 
cure," the value of which in the treatment of 
chronic bowel disorders has been well understood 
for centuries. The grape cure of Switzerland and 
certain parts of Germany, the cherry cure advo- 
cated by Linnaeus, the great botanist, and similar 
"cures" through the use of apples, peaches, and 
other fruits, practised in several countries, owe 
their value to the antitoxic properties of these 
choicest of Nature's products. 

The Antitoxic Laxative Diet 

Every constipated person, then, requires a bill 
of fare consisting of antitoxic and laxative foods. 
It is most essential that his diet should eliminate 
flesh foods of all sorts, including fish, oysters, fowl, 
as well as beefsteaks, chops, and other red meats. 
In many cases it is also wise to avoid eggs, or at 
least to use them very sparingly. Many persons 
find themselves able to digest the yolks of eggs, who 
cannot take the whites either cooked or raw with- 
out suffering inconvenience, because of the readiness 
with which this form of albumin undergoes putre- 
faction in the intestine. When eggs are freely 
eaten, especially if hard boiled or poached, or in 
the form of an omelette, portions of undigested 



DIET IN CONSTIPATION 227 

albumin may always be found in the stools, and in 
a state of very advanced putrefaction. The gas 
formed in the colon when eggs are freely used 
consists largely of sulphuretted hydrogen, which 
is toxic as well as offensive, and affords most sub- 
stantial evidence of the luxuriant growth of putre- 
factive bacteria in the colon. 

Those who have been accustomed to the free 
use of meat and eggs are sometimes afraid to dis- 
pense with them lest they should suffer from an 
insufficient supply of protein; but the experiments 
of Chittenden and the extensive practical experience 
of the Battle Creek Sanitarium have shown most, 
conclusively that the amount of protein required 
by the body is so small that it may readily be 
furnished by food derived exclusively from the 
vegetable kingdom. In other words, eggs, and 
meat, and even cow's milk, are quite superfluous 
as food, when a good variety of fruit, cereals and 
fresh vegetables are available. If, however, an 
additional supply of protein is required, it may 
readily be obtained from nuts. Peanuts, pine nuts, 
English walnuts and almonds are all rich in pro- 
tein; a pound of pine nuts, in fact, contains fifty 
per cent, more protein than a pound of lean beef, 
and besides, contains twice as much more nutrient 
in the form of a most easily digestible fat. Prac- 
tically the same thing may be said of almonds and 
peanuts. Any possible deficiency in protein may 
readily be made up by -taking at meals a handful 



228 COLON HYGIENE 

of any kind of nut meats. It is only necessary to 
take care to masticate them thoroughly, so that 
the protein present may easily be accessible to the 
digestive juices. A somewhat extensive study of 
the laxative and antitoxic properties of various 
foods will be found of practical value. 

Cellulose-Containing Foods 

All vegetable foods contain more or less cellu- 
lose, but the amount differs very greatly. This 
element, as has already been mentioned, is highly 
necessary as- a means of securing normal bowel ac- 
tion. Indeed, bulk, not simply in the food itself, 
but in the residues left behind after the absorption 
of the nutritive portions of the food, is of first 
importance. This quality in food is even more 
important than the antiseptic properties, for the 
reason that putrefactive bacteria may always find 
in the bile and other intestinal secretions abundant 
material to support their growth, provided sufficient 
delay occurs to encourage putrefactive changes. 
The thing most necessary in the prevention of 
putrefaction is rapidity of movement of food resi- 
dues and body wastes along the intestine to the 
exit. 

The following tables show the amount and. 
percentage of cellulose found in the dried sub- 
stance of various food stuffs: 



VEGETABLES 

Grains 
p«r ounce 

Dried Beans 40. 



Dried Peas 28.5 1 | 

Lentils 20. □ 



Green Peas 


9.35 Q 


Cabbage 


9-2 □ 


Parsnip 


8.65 □ 


Brussels 5proufs 


7.85 □ 


Kohlrabi 


7.75 U 


Celery 


7. D 


Turnip 


6.6 D 


Pumpkin 


6.1 D 


B. PoWo 


5.45 D 


Be>e4s 


5.25 


Asparagus 


5.2 D 


Carrots 


4.9 J 


vSpmach 


4.65 D 


Cauliflower 


4.55 D 


Tomatoes 


4.26 1 


Green Peas 


4. 1 


Cucumber 


3.9 | 


LeHuce 


3.65 1 


Onion 


3.55 J 



FRUITS 

Grams 

frr ounte 

Huckleberries 61.5 j_ 
Red Raspberries 37. 



BUcUerr.es 25. \ZZ\ 

Cranberries 25. 

Curran4s 23. □ 

Fi£s 22.5 □ 

Goosbernes \7.5 |_ 

Pears 15. D 



Apricots 


12.5 □ 


Prunes 


io. D 


Cherries 


io. D 


Strawberries 10. 


Oranges 


io. D 


Plums 


7.5 D 


Grapes 


7.5 □ 


Raisins 


75 D 


Stewed Raisins 7.4 Q 


Peaches 


5. D 


Apples 


5. D 


Bananas 


•3| 



Chart Showing Proportion of Cellulose in Some of the Common 
Vegetables and Fruits — Also Grains of Cellulose per Ounce 



Groins 
per ounce 



CEREAL5 

nl 

Bran 200 

Oatmeal 44. \ZZ 

Barley 20. □ 

%e 15. D 

Wheat 10. □ 

Corn Meal */\ 

Corn Flukes JU. LJ 

Crah«mFlour -ff\ 
Cranola 1VJ. LJ 

Rolled (\ n 

Wheat J. U 

Graham /-~ 

Bread O U 

Wheat Grill 



Whole W. Bread 1. U 

.75! 



Unpolished 

R.ce 



Polished 
R.ce 



rlour .«J 



4l 

3l 

>IET*5 



Normal Diet- Fruit. I 

Green Vegetables. 6- I 

Graham Bread 

Oatmeal 

Cracked Wheat I 1 

Ordinary Mixed | j 

While Bread fl 

and Milk LI 



Chart Showing Proportion of Cellulose in Some of ihe Common 
Cereal Foods— Also Grains of Cellulose per Ounce. 



DIET IN CONSTIPATION 229 
CEREALS 

en i 

9 m <m 

. "S 4 A d * | ||l 

4jU t <uCu ,„ a> o^rt C a- c aj 

S-3 |3.gg gg .£3g ru: 

fcO fco&o Ort OO.S o£«« 

Wheat (cooked) 2 10 26.3 38 30 

Wheat Grits (cooked) . 1 5 18.4 27 60 

Rolled Wheat (cracked) 2 9 26.3 36 30 

Graham Flour 2 10 104 9.6 30 

Fine Flour 3 1.5 101 1.4 200 

Oatmeal (cooked) 10 44 18 37 6 

Barley (cooked) 4 20 31.08 64 15 

Polished Rice 4 2 101.8 1.96 150 

Unpolished Rice 75 3.75101.8 3.68 82 

Rye (small) 3 15 104 14.4 20 

Corn Meal 2 10 103 9.7 30 

Corn Flakes 2 10 103 9.7 30 

Beans (dried) 8 40 100 40 75 

Peas (dried) 5.7 28.5 100 28.5 10 

Lentils 4 20 101.8 19.6 15 

Granola (cooked) 2 10 101.7 9.8 30 

Sterilized Bran 40 200 1.5 

Graham Bread 1.2 6 76 8 50 

Whole Wheat Bread ..1 5 71.7 7 60 



VEGETABLES 



.5 £ I > 






Asparagus 5.2 13.9 37.4 57.7 

Beans 4 30.96 12.9 75 

Beets v .. 5.25 11.6 45 57 

Brussels Sprouts 7.85 6 131 40 

Cabbage 9.2 8.8 145 32.4 

Carrot (raw) 4.9 14 36 60 



230 COLON HYGIENE 

Cauliflower (steamed) 4.55 10.2 44.6 66 

Celery (raw) 7 5.5 127 45 

Cucumber (raw) 3.9 5 78 75 

Green Peas 9.35 34.4 27 32.2 

Kohlrabi (raw) 7.75 9 86 39 

Lettuce 3.65 5.6 65 82 

Onion 3.55 10.52 33.7 85 

Parsnips 8.65 17.1 50 36 

Peas (dried) 28.5 103 27 10.8 

Potato (baked) 5.45 32.7 16.6 55 

Pumpkin 6.1 9.3 65.6 50 

Spinach 4.65 9.3 50 65 

Tomatoes 4.20 6.6 63.6 71 

Turnip 6.6 6.1 108 46 

FRUITS 



§£ 

O p) 
>h3 
0) 0J 

PhO 

Prunes (cooked) 2 

Apples 1 

Pears 3 

Peaches 1 

Plums 1.5 

Cherries 2 

Baspberries, red 7.4 

Blackberries 5 

Huckleberries 12.2 

Strawberries 2 

Currants 4.6 

Grapes 1.5 

Eaisins 1.7 

Eaisins (stewed) .... 1.7 

Oranges 2 

Bananas 3 

Figs 4.5 

Apricots 2.5 

Gooseberries (stewed) 3.5 

Cranberries 5.0 



. <U C o 

3*3 2 s 

ZO MO 



10 

5 
15 

5 

7.5 
10 
37 
25 
61 
10 
23 

7.5 

7.5 

7.4 
10 

1.5 
22.5 
12.5 
17.5 
25 



P 



27.5 
101 
18.5 
12.8 
24.7 
22.8 
18.3 
16.8 
21.5 
11.4 
16.7 
20.3 
100.3 
100.6 
14.9 
28.9 
92.4 
16.3 
19.4 
48 



o3.2 ot 



36 
5 

81 

40 

30 

44 
200 
150 
300 

87 
138 

36 

38.4 

67 

5.2 
24.3 
74 
90 
51 



8g° 

C*M.S « 
8©gS 



© P S 

CO o 



30 

60 
20 
60 
40 
30 
81 
12 
5 
30 
17 
40 
30 
40 
30 
200 
13.3 
24 
17 
12 



DIET IN CONSTIPATION 231 

Sterilized Wheat Bran 

One of the oldest and certainly the most valu- 
able remedy in the treatment of constipation is ordi- 
nary wheat-bran. Bran consists almost entirely or 
very largely of cellulose in an indigestible form. 
While wheatmeal contains 2.5% of cellulose, bran 
contains 18%, and in some cases even more. In 
the form of bran, cellulose is well broken up, and 
hence can be passed through the intestine without 
difficulty. The apprehension which some authors 
have expressed concerning the irritating effects of 
bran are wholly without basis, except, of course, that 
one would not think of using bran in a case of 
gastric ulcer or acute inflammation of the stomach 
or intestines: As a matter of fact, when well soft- 
ened with water, bran is no longer irritating, but 
is an emollient. The thin films of cellulose become 
as soft and pliable as wet paper, and excite the 
bowel, not by scratching or irritating it, but by a 
gentle titillation, so to speak, and by giving to the 
food sufficient mass to distend the intestine and 
stimulate it to vigorous activity. 

In its ordinary commercial form, bran is scarce- 
ly fit for use, on account of the large amount of 
dirt which it contains, including multitudes of 
bacteria. For intestinal use as a laxative, it should 
be carefully prepared by thorough cleaning and 
washing of the wheat before grinding and steriliza- 
tion of the bran. Sterilized bran, first introduced 



232 COLON HYGIENE 

by the writer several years ago, is now prepared by 
various manufacturers, and is put up in convenient 
packages. One or two rounded tablespoonfuls 
should be taken at each meal, the amount depend- 
ing upon the character of other foods taken. The 
writer has never seen any ill effects from the use of 
sterilized bran which he has prescribed for many 
years, although there are cases in which it fails to 
produce the desired effect and has to be supple- 
mented by the use of paraffin oil as a lubricant. 

This is particularly true in cases in which the 
cecum is greatly dilated or crippled by adhesions and 
in cases in which there is obstruction of other parts 
of the colon, especially the pelvic colon as the result 
of adhesions. 

The combination of paraffin oil with bran or 
agar-agar in some form is also useful in cases of 
spastic contraction due to colitis. 

Experience shows that from an ounce to two 
ounces of cellulose must be taken with the food 
daily, to insure sufficient bulk to stimulate the 
intestine to action. In cases in which the colon 
is very redundant or is crippled by adhesions, even 
double this amount may sometimes be needed, at 
least until the bowel has been trained to normal 
action. This amount of cellulose is provided by 
two rounded tablespoonfuls of sterilized bran in 
addition to other laxative foods. 

The amount of food required to furnish an ounce 
of cellulose may be ascertained by reference to the 
foregoing tables. 




Crude Agar-Agar 




Agar-Agar in Sterilized and Edible Form 



DIET IN CONSTIPATION 233 

It should further be mentioned that in the use 
of cellulose in concentrated form as in sterilized 
bran, the whole amount used at a meal should not 
be taken at once, as at the beginning or end of the 
meal, but should be well mixed with the food by 
taking small portions at frequent intervals during 
the meal. 

Agar-Agar 

The use of agar-agar, a Japanese sea-weed of 
a nature similar to Iceland moss, is to be most 
highly recommended as a means of giving the neces- 
sary bulk to stimulate the intestine to prompt ac- 
tion. 

It may be used without any possible injury in 
all cases of sluggish bowel action. When properly 
prepared it is wholly free from unpleasant flavor, 
and it manifests such astonishing avidity for water 
that when it is present in the feces they cannot pos- 
sibly become dry and hard. 

In cases in which constipation is due to "greedy 
colon," agar-agar or bran is indispensable. In such 
cases the colon has acquired the power to eat up 
enormous quantities of the cellulose of the food, so 
that it is very difficult to increase the bulk of the 
feces by the use of green vegetables. This is the 
reason for the disappointment experienced by many 
who hope to find in the free use of lettuce and like 
green foods a panacea for their intestinal ills. 
Agar-agar is hemi-cellulose, and has been shown by 



234 COLON HYGIENE 

the experiments of Mendel and others to be indi- 
gestible by any of the digestive fluids with which 
it comes in contact in the human body. Agar-agar 
must be taken in sufficient quantity to accomplish 
the object sought. Two-thirds of an ounce to an 
ounce is the quantity usually required for adults. 
For young children a quarter to a half of this 
quantity is sufficient. 

Agar-agar is easily taken in soup, cereal coffee, 
fruit juice or stewed fruit. It should be allowed 
to soften and should then be swallowed without 
chewing. 

This remedy should be taken at meals in order 
that it may be well intermingled with the food, and 
so prevent the formation of hardened residues in 
the intestine. 

Agar-agar may be used with advantage as a 
substitute for a meal, when food cannot be taken, 
and when there is no appetite for food, and when 
so used it maintains the intestinal rhythm which 
would otherwise be lost, resulting in constipation. 
It should in such cases be taken with fruit juice or 
fresh or stewed fruit. When one finds at night 
that the usual amount of food has not been taken, 
an extra dose of agar-agar with a little fruit may 
be taken before going to bed. No digestive work 
is required by either the fruit or the agar-agar ex- 
cept to move it along the digestive canal. It is 
important to take fruit or fruit juice with the 
agar-agar to excite the necessary peristalsis. 



DIET IN CONSTIPATION 235 

Number and Size of Meals 

In very many cases of chronic constipation the 
colon, especially the cecum, has become so dilated 
that it is seriously crippled. Its thin, atrophied 
walls are unable to handle large masses of material. 
In such cases, large bulky meals are likely to over- 
weight the cecum and to form an impaction which 
may remain for days, giving rise to fermentation, 
distention of the colon with gas, colic pains, and 
great inconvenience. Complaint is often made 
that bulky foods cause much flatulence and distress 
and seem to increase the constipation. The remedy 
is not to be found in discarding "coarse vegetables'" 
or other bulky foods but in taking smaller and more 
frequent meals. By this means the amount of 
material present in any portion of the bowel at any 
particular time will be reduced, the bowel will 
never be over distended, and will have an oppor- 
tunity gradually to recover its normal tone. 

The proper plan for the meals in such a case is 
to take two principal meals and two minor meals. 
The principal meals should contain the chief part 
of the nutriment; the minor meals should make 
small demands upon the digestive organs; the bulk 
should be about the same for each of the four meals. 
No fats should be taken at the minor meals and 
nothing requiring more than two hours for gastric 
digestion. It is best to confine the minor meals to 
fruit and cellulose. 



236 COLON HYGIENE 

The cellulose may be taken in the form of bran 
mush, bran cakes, colax, (Japanese sea weed or 
Ceylon moss), or laxa, (sterilized bran and agar- 
agar). Any sort of fresh juicy fruit may be eaten, 
but bananas, dates, dried figs and raisins should 
be avoided. Fresh figs or raw soaked purple figs 
are excellent. Soaked raw prunes are also very 
good indeed. 

The arrangement of the four meals as regards 
time may be the following: first, breakfast on ris- 
ing, say 6:30 a. m., fruit and bran; second break- 
fast, 9 :00 a. m. ; dinner 3 :00 p. m. ; fruit lunch at 
bedtime. If these hours are not convenient, some 
other arrangement may be made, care being taken 
to avoid taking meals too near together. 

The Use of Bran 

Wheat bran is perhaps the most useful of all 
food remedies for constipation. Bran may be 
taken by itself or it may be used in many combina- 
tions. Care must be taken to obtain clean bran, 
which is not always easy, for the reason that the 
bran is usually mixed with much dirt and offal 
removed from the grain. To be fit for use, the 
bran should be taken from wheat which has been 
specially cleansed and washed. The bran should 
be cooked and sterilized to destroy any adhering 
germs. 

Such bran only needs softening and is ready for 






DIET IN CONSTIPATION 237 

immediate use. It may be eaten as a breakfast 
cereal or it may be mixed with any other suitable 
food such as oatmeal, toasted flakes, or even mashed 
potatoes or boiled rice. 

Sterilized bran may be added to bread, biscuit, 
cake and breakfast cakes in proportion of one- 
fourth or even more. It should be used freely at 
every meal. Numerous excellent recipes are now- 
available for using bran in various palatable and 
efficient ways. 

Recipes for the Use of Bran 

BRAN AND OATS 

1 cup rolled oats 

1 cup sterilized bran 

2 Vl cups water 
1 teaspoon salt 

Heat the water to boiling. Add the salt, bran 
and the rolled oats. Let boil five minutes. This 
dish is a good corrective measure and at the same 
time an excellent breakfast food. 

STERILIZED BRAN 

Look over and remove foreign substances from 
bran and place in a rather shallow pan in a mod- 
erate oven. Place a pan of hot water in the oven 
to prevent burning. Bake a half hour, stirring the 
bran often to prevent scorching. Grind in a coffee 
mill. 



238 COLON HYGIENE 

BRAN AND GRANOLA MUSH 

1 cup sterilized bran 

1 cup granola 
3 cups water 

\y 2 teaspoons salt 

Mix the bran, granola and salt. Stir into the 
boiling water and cook for a few minutes directly 
over the flame. 

GRAHAM BREAD 

3 cups milk and water (equal parts) 

2 tablespoons malt honey or molasses 
1/^ cups sterilized bran 

About 2 quarts whole wheat flour 

2 teaspoons salt 

!j^ yeast cake 

34 cup warm water 

Soak the yeast in the warm water. Scald the 
milk and cool to lukewarm. Potato water may 
be used instead of the milk and water. Add water, 
the molasses and salt, then the softened yeast. Mix 
the flour and bran together and stir into the liquids. 
Knead thoroughly, and put to rise in a warm place. 
When light, mold into a loaf. Let rise again, and 
when light bake in a hot oven about one hour. De- 
crease the heat somewhat during the latter part of 
the baking. This makes 3 small or 2 large loafs. 
Graham flour may be used instead of the whole 
wheat, in which case less bran will be needed. 



DIET IN CONSTIPATION 239 

BRAN GRAHAM BISCUIT 

1 cup sterilized bran 

2 cups graham flour 
1 cup milk 

1 egg 

2 teaspoons sugar 

1 teaspoon salt 

2 tablespoons butter 
1 teaspoon soda 

80 minims hydrochloric acid (C. P.) (This 
amount of soda and hydrochloric acid is equivalent 
to 4 teaspoons baking powder.) 

Mix the flour, bran, sugar, and salt together. 
Beat the egg slightly and add to the milk. Dis- 
solve the soda in the milk, and add the melted but- 
ter. Lastly, add the hydrochloric acid. Turn 
very quickly into the dry ingredients. Mix lightly 
but quickly. Turn upon a molding board and 
shape with a biscuit cutter and bake fifteen to 
twenty minutes in a hot oven. 

If baking powder is used, omit the hydrochloric 
acid and the soda, and proceed as follows: Mix 
the dry ingredients together, beat the egg slightly, 
and add to the milk. Stir the liquids into the dry 
ingredients the same as for cream biscuits. Turn 
out upon a slightly floured molding board and roll 
to one-half inch in thickness. Cut into shape with 
the biscuit cutter and bake in a hot oven. 



240 COLON HYGIENE 

BRAN GEMS 

1 cup sterilized bran 

1 cup graham flour 

% cup milk 

3 tablespoons melted butter 

1 teaspoon salt 

1 egg 

1 tablespoon sugar 

24 teaspoons soda 

60 minims hydrochloric acid (C. P.) (This 
amount of soda and hydrochloric acid is equivalent 
to 3 teaspoons of baking powder.) 

Mix the bran, flour, salt and sugar together. 
Beat the egg, add the milk and one-half of the dry 
ingredients. Stir in the hydrochloric acid. Mix 
well and add the melted butter. Sift the soda with 
the remaining half of the dry ingredients and stir 
into the batter. Turn into buttered muffin pans 
and bake in a hot oven twenty to thirty minutes. 

BROSE 

Mix equal parts of cornmeal, steel-cut oats, and 
sterilized bran. Stir into three times its bulk of 
boiling water. As soon as the mixture thickens, it 
is ready to eat. Should not cook over four or five 
minutes. This simple mixture will be found a most 
efficient and satisfactory laxative breakfast food. 
Eat with cream, butter, fresh or stewed fruit. 



Baths and Other Home Treatments 
for Constipation 

Water may render great service in constipation, 
through the general improvement in health which 
may be secured by its sytematic use. Cold water 
is of the greatest service. The short spinal douche 
is one of the most effective means which can be 
employed for improving the tone of the nervous 
system. 

The inactive skin, due to the general saturation 
of the body with toxins, is an indication for sweat- 
ing baths. In constipation these should be made 
short, however, barely long enough to stimulate the 
skin to vigorous perspiration, and should be im- 
mediately followed by a short general cold applica- 
tion, including a cold douche to the spine, abdomen 
and legs. Short, cold applications applied to the 
surface cause reflex contraction of the internal in- 
voluntary muscles. It is for this reason that plac- 
ing the feet, sometimes even the hands, in cold 
water will often produce a desire to empty the 
bladder, through stimulation of the urinary centre. 

The defecating centre and intestinal rruscles may 
be stimulated in the same way. Various local ap- 
plications are of great service in improving the tone 
of the bowels, though local cold applications must 
be used with great discretion and with careful 

241 



242 COLON HYGIENE 

knowledge of the exact nature of the case; for the 
tendency of cold to produce contraction of the in- 
voluntary muscles leads to an aggravation of the 
condition in colitis with spastic constipation. 

Of the many different modes of applying cold 
water, which may be of service, the following are 
especially recommended : 

The Exercise Bath 

Swimming is undoubtedly the best form of bath, 
as well as the best form of exercise for general 
hygiene effects. Unfortunately, facilities for this 
natural exercise bath are not available for the ma- 
jority of persons, especially during the winter sea- 
son. Some time ago, it occurred to the writer that 
most of the advantages of the swimming bath might 
be secured by combining exercise with the cold bath 
in an ordinary bath tub. The following is a de- 
scription of the rowing or surf bath as it is in use 
at the Battle Creek Sanitarium: 

The patient sits in a bath tub partly filled with 
water, and dips water over himself while at the 
same time executing the movements of rowing. The 
temperature of the water may be 100° F. at the 
start, but should be rapidly lowered by opening the 
cold water faucet and, if necessary, letting out part 
of the water while the cold water is running in. 
The rowing and dipping apparatus consists of a 
pair of handles to which is attached a dipper and 




The Bath Exerciser, or Surf Bath 




The Pouring Douche 



BATHS AND OTHER HOME TREATMENTS 243 

a rubber cord. The bather fills the bowl as he 
reaches forward, then dashes the water over his 
body as he pulls the bowl towards his chest and 
bends his body back. Strokes are made at the rate 
of about thirty per minute. From one hundred to 
one hundred and fifty strokes are made. The tem- 
perature of the water grows continually colder to 
the close of the bath or until pipe temperature is 
reached. A temperature of 70° F. to 65° F. is 
easily borne, and one finishes the bath with the 
same delightful sensation of warmth and glow 
which one feels after a swim in the surf. The tem- 
perature of the water is, of course, under perfect 
control, an advantage over sea bathing; and the 
work done may be made as vigorous as one desires. 

This exercise bath is most excellent for persons 
suffering from constipation. The impact of the 
cold water upon the surface of the abdomen re- 
flexly stimulates intestinal activity. 

The exercise bath is especially valuable in cases 
of obesity. Both the exercise and the cold water 
help to burn up the excessive accumulation of fat 
in the abdominal wall and within the abdomen. 

The Cold Douche 

A short cold douche to the lower part of the 
back, buttocks, abdomen and feet. The tempera- 
ture should be 70° to 50° F., and the duration ten 
to thirty seconds. With patients who are not ac- 



244 COLON HYGIENE 

customed to applications of cold water, the tem- 
perature of the douches should at first not be lower 
than 70°. This should be gradually lowered at 
each application until the temperature of 60° to 
50° is reached. In general, the douche should be 
preceded by a short hot bath to prepare the patient 
for the cold application, and to secure prompt re- 
action, which is still further encouraged by exer- 
cise after the bath. 

The Simultaneous Hot and Cold Douche 

A very excellent form of bath especially adapted 
to cases of constipation, is the simultaneous warm 
shower bath (100° F.), with short cold douche 
to the abdomen. The warm shower bath should 
be applied for half-a-minute so that the skin will 
be thoroughly warm first, and the cold spray or 
broken jet should be applied to the abdomen with- 
out interrupting the warm shower. The tempera- 
ture of the spray should be 70° to 50°. The dura- 
tion of the cold application should be not more 
than a minute. At the end of the bath a short 
general cold application lasting no more than ten 
to fifteen seconds should be made to secure reaction, 
and thus fix the blood in the skin. 

Abdominal Pouring Douche 

When a douche apparatus is not available, a 
very efficient abdominal douche may be applied in 




Applying a Wet Girdle 



BATHS AND OTHER HOME TREATMENTS 245 

an ordinary bath tub. A hot bath at the tempera- 
ture of 102° to 103° should be applied for one to 
three minutes. Then the outlet should be opened 
and cold water should be poured on the abdomen 
while the water is running out. By lifting the dip- 
per to the height of five or six feet a sufficient de- 
gree of force may be obtained to produce a decided 
reflex effect. The temperature of the water may 
vary from 60° to ice cold, the temperature being 
gradually lowered as the patient becomes accus- 
tomed to the cold application. 

Hot Sitz and Cold Pour 

The patient sits in water at a temperature of 
102° or 103° for two or three minutes, then leans 
back in the tub while the attendant pours cold water 
70° to 50° over the abdomen for half a minute. 

Rubbing Cold Sitz Bath 

In this bath the patient sits in water at a tem- 
perature of 75° to 55° for two minutes, rubbing 
himself vigorously meanwhile. This bath produces 
a powerful reflex influence upon the intestines, es- 
pecially in the colon, and is frequently followed 
soon after by a desire to defecate. The patient 
should rub himself continually during the bath, 
and the feet may be kept in hot water if there is 
a tendency to chilliness. The shoulders should be 
covered by a woolen blanket. 



246 COLON HYGIENE 

The Sedative Sitz Bath 

A bath at the temperature of from 60° to 70° 
for fifteen to twenty minutes produces powerful and 
prolonged contraction of internal muscular struc- 
tures. This bath is useful in diarrhoea, and is one 
of the most efficient means of improving the tone 
of the abdominal muscles and of an atonic colon. 
This bath should not be given in cases of spastic 
constipation. In general, prolonged cold baths of 
any sort, (that is, baths longer than two or three 
minutes), are aggravating in this condition. 

Alternate Applications to the Abdomen 

A hot fomentation to the abdomen for five to 
ten minutes, followed by a cold application for one 
minute, is an excellent means of stimulating peristal- 
sis and improving the muscular tone. The cold 
application may consist of a compress of ice water, 
but the most effective method is to rub the abdomen 
with a smooth piece of ice. The effect of this ap- 
plication is increased by repeating the alternation 
two or three times in succession. 

The Wet Girdle 

This is a simple method which has been used 
for centuries by the peasantry of Europe. The ab- 
dominal girdle consists of a coarse towel of three 
yards in length, half of which is wet, the other half 
remaining dry. Beginning with the wet end, the 



BATHS AND OTHER HOME TREATMENTS 247 

towel is wound round the trunk of the body, great 
care being taken to see that it fits the skin snugly. 
Outside the towel a flannel bandage is applied. The 
towel should be changed before it becomes dry. It 
should be worn night and day to secure the most 
pronounced effect. The mackintosh or oiled mus- 
lin, often applied with the moist bandage, should 
be omitted when it is the purpose to relieve con- 
stipation. 

Fomentation to the Abdomen 

The abdominal fomentation is a capital means 
for use in spastic constipation, the result of colitis, 
and when the ileocecal valve is in a state of spas- 
modic contraction due to chronic appendicitis or 
ovarian disease. In general the fomentation is 
highly useful in all cases of constipation accom- 
panied by pain in the abdomen, no matter what the 
cause. 

The electric fomentation heater is a convenient 
means of heating a fomentation compress. 

The best time for applying the fomentation is 
soon after breakfast, or shortly before the regular 
time for moving the bowels. Applications may be 
made with great advantage two or three times 
daily, or at least morning and night, so as to relax 
the colon several times during the day. 

In very pronounced cases of colitis, with spastic 
constipation, a short very hot bath is of great ser- 
vice. The duration of the bath should not be more 



248 COLON HYGIENE 

than two to four minutes. It produces debility 
and anemia if long continued and often repeated. 
The effect of hot applications is to lessen the ir- 
ritability of the nerve centers, and thus to relieve 
the intestinal spasm which may be due to conges- 
tion or inflammation of the appendix, ovaries, 
bladder, rectum or gall-bladder, or still more often, 
to colitis. 

Combined Hot Bath and Hot Douche 

Perhaps the most effective measure for the relief 
of intestinal spasms, such as sometimes occurs in 
muco-membranous colitis, is a warm bath (100° F.) 
combined with a very hot spray to the abdomen. 
The water should be allowed to fall on the abdo- 
men in very fine streams with very little force, at 
a temperature of 115° to 120°. The duration of 
the application should be two to five minutes. It 
should be followed by a cold application at a tem- 
perature about 80° for one or two minutes. 

The Hot Sitz 

The hot sitz bath at a temperature of 112° to 
118°, duration two to three minutes, cannot be 
too highly praised as a measure of the highest value 
for use in the treatment of reflex and spastic con- 
stipation, with or without colitis. After the sitz 
no cold application is made. The best time for the 
bath is on rising in the morning. 




t_ti _ J 

Photophore (above) and Thermophore (below) 



BATHS AND OTHER HOME TREATMENTS 249 

The Photophore, and the Electric 
Thermophore 

These are measures of great value in the treat- 
ment of spastic and reflex constipation, and are 
especially useful in cases in which pain is a pro- 
nounced symptom and a cause of reflex spasm. The 
applications should be made morning and night in 
place of the fomentation, and are much more ef- 
fective. 

The Enema 

There are unquestionably certain cases in which 
the colon has become so crippled by inflammations, 
stretchings, distortions, adhesions and the degenera- 
tion of its muscular structures, and consequent 
weakening of its contractile powers, that it can no 
longer be made to perform its functions, even by 
the use of such accessories as act as mechanical or 
physiological aids. In such cases and in certain 
emergency cases, the judicious use of the enema is 
not only helpful, but sometimes necessary. For 
example, in cases of senile constipation, where as 
the result of long continued colitis, the muscular 
walls are thin and greatly stretched, while the 
colon itself has become abnormally redundant and 
folded upon itself, the daily or frequent use of the 
enema may be required. 

The best means of administering the enema is 
the fountain syringe. The tube should be long 



250 COLON HYGIENE 

enough so that the reservoir, if necessary, may be 
raised to a height of five or six feet above the pa- 
tient. When it is desired to stimulate the bowel 
to immediate contraction, the reservoir should be 
placed high, but when the purpose is to introduce 
as large quantity of water as possible into the colon, 
and to have it retained for a time, the reservoir 
should be placed at a height not exceeding two or 
three feet. 

The position of the patient during the adminis- 
tration of an enema is not a matter of very great 
importance. In cases in which the pelvic colon is 
low down in the pelvis, as is shown by examination, 
it is well to put the patient in a knee-chest position. 
The water should be introduced very slowly. Or- 
dinarily, however, the patient may lie upon the 
back or either side, or the enema may even be ad- 
ministered standing. The water quickly finds its 
way along the colon, no matter what the position 
of the patient may be. 

The use of the colon tube is quite unnecessary. 
Indeed, as the writer learned long ago by experience, 
and as has been abundantly proved by examination 
with the X-ray, the colon tube can rarely ever be 
introduced beyond the rectum. It is arrested at 
the pelvi-rectal fold, and simply returns and coils it- 
self up in the rectum. A tube long enough to pass 
the water through the anus is as useful as the longest 
colon tube, unless the long tube is passed into the 
pelvic colon past the ileosplenic flexure, a procedure 



BATHS AND OTHER HOME TREATMENTS 251 

which is rarely required, and, of course, should only 
be undertaken by a physician. 

The enema may be employed in a variety of 
ways adapted to different occasions and purposes, 
and it may be repeated as many times as may be 
necessary. Warm water dissolves hardened fecal 
matters much more readily than cold water, yet in 
some cases it may be necessary to repeat the enema, 
at intervals of fifteen to twenty minutes, five or 
six times before the effect desired is obtained. When 
used for the purpose of softening hardened fecal 
matters, the water should be introduced slowly, 
and the patient should be instructed to retain as 
much as possible. The enema should be repeated 
as long as the water contains fecal matters when 
returned. 

The Hot Water Enema 

The temperature of the water should be 105° 
to 115° F. The quantity may be from one to three 
pints. This is preferable in cases of colitis and when 
abdominal pain or tenderness is present. 

The Hot Soap Enema 

The addition of soap to the water somewhat in- 
' creases its power to dissolve hardened feces, al- 
though the advantage of its use is not so great as 
might be supposed. The amount of soap should 
be sufficient only to make very weak suds, as other- 



252 COLON HYGIENE 

wise, it may be irritating, especially if the soap con- 
tains a considerable amount of free alkali. Ordinary 
soap is best for the purpose. 

The Hot Saline Enema 

Half an ounce of salt is added to two quarts of 
water at a temperature of 105° to 115° F. 

The purpose of the addition of salt is to lessen 
the irritation of the mucous membrane. It is of 
special use in cases of colitis, in which the enema 
is administered for the purpose of removing mucous 
and relieving spasms of the intestine. The applica- 
tion should be repeated until no mucous returns 
with the water. Care must be taken to secure 
evacuation of the water so as to avoid retention of 
a large amount of salt, which may do serious in- 
jury. 

The Cold Water Enema 

A cold application to the interior of the bowel 
is one of the most powerful means of stimulation 
which can be safely employed. Half a pint of water 
at a temperature of 50° will usually set up a very 
strong and painful contraction of the lower bowel. 
It is on this account necessary to begin with a mod- 
erate temperature. The first enema should have 
a temperature of 80° to 85° F. The temperature 
may be lowered on each application five to ten de- 
grees, or until sufficient powerful contractions are 



BATHS AND OTHER HOME TREATMENTS 25* 

produced to expel quickly the water introduced. By 
gradually reducing the temperature in this way, 
one as low as 40° may finally be used without 
causing excessive pain. Such low temperatures 
are very seldom required except in dysentery, in 
w r hich they often render great service. 

The cold enema is of special use in cases in which 
the colon has become gradually dilated and has be- 
come atonic, and contracts with insufficient force 
to expel its contents. In such cases a warm or hot 
enema is usually retained. By following the warm 
enema with half a pint or a pint of water at 60° 
to 70° F., prompt contraction of the bowel almost 
invariably follows, with expulsion of the bowel con- 
tents. This is a very important practical use of the 
cold enema, as the retention of the water in cases 
in which the bowel is filled with putrefying fecaL 
matters is very often followed by very unpleasant 
and even serious effects, through the absorption of 
enormous quantities of toxic substances, which are 
dissolved by the water and brought into contact 
with the absorbing surface of the bowel. In such 
cases the hot enema should be immediately followed 
by a small cold enema, and the cold enema should 
be repeated several times, if necessary. 

The Oil Enema 

The amount of oil required is four to sixteen 
ounces. Either pure olive oil or any sweet oil may 



254 COLON HYGIENE 

be employed. The latter is just as good as the 
former, and is less likely to produce nausea and 
vomiting, which sometimes follows the use of olive 
oil of an inferior grade. The temperature of the oil 
should be 104°. As a means of softening hardened 
feces, oil is no better than water; in fact, accord- 
ing to the writer's experience, it is less efficient. It 
is useful, however, as a means of lubricating the 
lower bowel, and when introduced at night pre- 
vents hardening and drying of the feces. For this 
purpose 4 to 6 ounces should be introduced at night. 
When used for the purpose of lubrication only, a 
good plan is to administer the oil before breakfast. 
This is an excellent means of securing a thorough 
evacuation of the colon. 

Sugar and Water Enema 

Sugar is a powerful stimulant of the colon. A 
very old-fashioned remedy is the introduction of 
molasses into the colon. To half a pint or pint of 
molasses an equal quantity of hot water is added. 
A prompt action of the colon usually follows the 
introduction of this mixture. The writer has for 
years used malt sugar for this purpose, and with 
most satisfactory results. The malt sugar not only 
acts as a stimulant to the bowel, but at the same 
time furnishes valuable nourishment. Four ounces 
of malt sugar should be added to a pint of water. 



BATHS AND OTHER HOME TREATMENTS 255 

Paraffin Oil Enema 

Liquid paraffin, or paraffin oil, may be used as 
an enema in place of olive oil and other oils, and 
has the advantage that it does not produce nausea 
or other unpleasant symptoms. Paraffin oil is bet- 
ter than any animal or vegetable oil, for the reason 
that it is not a fat, and is not absorbed, neither will 
it undergo fermentation. The oil enema often 
causes nausea, loss of appetite, and coating of the 
tongue. This may be avoided by the use of paraffin 
oil. Only the specially purified refined white Rus- 
sian oil should be used. 

The Alum Enema 

In cases in which the bowels cannot be made to 
move promptly by other means, alum has been found 
to be effective. A teaspoonful of powdered alum 
is used in a quart of water. By using cool water 
70° to 80° the effect may be increased. 

The Glycerine Enema 

Pure glycerine introduced into the rectum in a 
quantity of one to four ounces is a useful means 
of stimulating bowel movements, by bringing about 
the defecating reflex. When pure glycerine is 
found to lead to too much irritation, as is some- 
times the case, it should be used with an equal 
quantity of water. 



256 COLON HYGIENE 

The Cold Rectal Douche 

By introducing cold water into the rectum with 
considerable force, a most powerful stimulation may 
be produced. The temperature of the water should 
be 70° to 80° F. If the stream furnished by the 
ordinary fountain douche has not sufficient force 
for this, a bulb syringe is necessary. 

In administering the rectal douche a return tube 
should always be used, so that the rectum will not 
be over-distended. A small tube should be connected 
with the syringe, and a large one should be intro- 
duced alongside it, to counteract over-distension of 
the rectum. When the powerful stimulation of the 
rectal douche is required, it is not desired to secure 
the stimulation which results from distention of the 
rectum, for in these cases the rectum is always re- 
laxed, and has to a certain degree lost its contractile 
power. It is desired only to obtain the stimulating 
effects produced by a low temperature and the im- 
pact of a stream of water introduced with consider- 
able force, the effect of such an application is to 
produce almost immediately a very strong defecat- 
ing reflex, with contraction of the pelvic colon and 
forcible expulsive efforts. 

It is well that the enema tube should be intro- 
duced its full length and should be directed some- 
what backward, so that the stream of water may 
be received upon the upper part of the rectum and, 
if possible, reach the pelvi-rectal fold. 



BATHS AND OTHER HOME TREATMENTS 257 

In cases in which the sensibility of the rectum is 
largely lost, this measure affords a very excellent 
means of restoring normal sensibility. In extreme 
cases the alternating rectal douche may be employed, 
using first water at a temperature of 115°, then 
water at a temperature of 60° to 70°. In some 
extreme cases the temperature of the water is as 
low as 40° or 50°. The application should be 
made every ten seconds. 

Injury from Drug Laxatives 

While the temporary use of medicinal laxatives is 
sometimes necessary, and always justifiable when 
required as an emergency means, there can be no 
doubt that the continued use of drugs of any sort 
is highly injurious to the intestines, and in many 
cases to other organs with which the drug comes 
in contact, particularly the liver and kidneys, which 
are burdened with the elimination of a certain part 
of the drugs employed. 

All laxative drugs are irritant poisons. They 
affect the stomach as well as the colon and small 
intestine. Their long continued use in time gives 
rise to gastric and intestinal catarrh, colitis and the 
varied evils which accompany these disorders, es- 
pecially hemorrhoids, appendicitis, intestinal tox- 
emia and certain aggravation of the constipation 
which they are given to relieve. 

Most drugs which act upon the bowels produce 



258 COLON HYGIENE 

their effect only after having been absorbed and 
circulated through the blood. This has been proved 
to be true even in the case of saline laxatives, which 
are absorbed in the upper part of the intestine, and 
acting through the nerve centers controlling the 
colon, produce a laxative effect long before the drug 
has reached the colon through the intestine. 

The effects of many other laxative drugs may be 
produced by injection under the skin. 

It is thus evident that the action of laxative 
drugs is not confined to the intestine, but through 
absorption into the blood stream these irritating 
substances are brought into contact with all the 
tissues. 

Among the most largely used laxative drugs are 
aloes, senna, rhubarb and cascara. All of these 
drugs contain substances which are irritant poisons 
derived from anthracene. 

According to Levin, when a preparation of aloes 
is "employed for a length of time, there occurs, in 
consequence of the persistent congestion of the 
descending colon and rectum, dilation of the hemor- 
rhoidal veins." Fallopius said that "out of a hun- 
dred persons who make habitual use of aloes, ninety 
are attacked by hemorrhoids." 

Sollman says that: "When injected hypoder- 
mically, aloin causes a tubular nephritis, acute 
Bright's disease." The extensive use of this ir- 
ritating drug in various popular laxative drugs and 
much advertised nostrums may well be one of the 



BATHS AND OTHER HOME TREATMENTS 259 

active causes of the alarming increase in disease 
of the kidneys, which has occurred within the last 
thirty years. 

Rhubarb, according to Sollman, contains a poison 
that produces a secondary constipation. 

Saline laxatives throw an enormous burden upon 
the kidneys, and when often repeated give rise to 
a very obstinate colitis. 

They also impair digestion, in time, setting up 
gastric and duodenal catarrh and producing achylia,, 
a condition in which the stomach glands produce 
no hydrochloric acid, thus leaving both the stomach 
and the intestine a prey to the various sorts of per 
nicious bacteria which are constantly finding their 
way into the stomach through the mouth, especially 
through the medium of flesh foods, milk, and 
cheese. 

The effects of laxative mineral waters are es- 
sentially the same as those of saline laxatives, which 
they are. 

Saline laxatives are particularly injurious to bed- 
ridden patients, because of the slow emptying of 
the stomach usual in such cases, in consequence of 
which the stomach is more than ordinarily damaged. 

Calomel, a drug which since the time of Paracel- 
sus has been extensively used as a laxative, and in 
conditions resulting from constipation, one of the 
most common of which is popularly known as 
"biliousness," is often a potent remedy, affording 
prompt relief, but when its use is often repeated, it 



260 COLON HYGIENE 

becomes a highly dangerous and injurious agent. 
All metallic drugs are combated by the liver, 
which absorbs as much as possible of the poison 
into its own tissues as a means of protecting the 
rest of the body. Thus the liver is particularly 
subject to injury. Bennett, of Edinburgh, showed 
more than a hundred years ago that calomel does 
not increase the action of the liver, and his observa- 
tions have been in recent years confirmed by Ruther- 
ford and others. 

Every chronic sufferer from constipation should 
know that there is no laxative drug known, the 
constant use of which is harmless. All laxative drugs 
are irritants. The more certain their action as laxa- 
tives, the more certainly will their continuous use 
for any length of time be followed by serious in- 
jury. Said an eminent German physician, "Nothing 
is so bad as the chronic use of laxative drugs." 

White Russian Paraffon Oil 

Dr. Neville Wood some years ago, suggested the 
use of pure liquid paraffin, a product of petroleum. 
Schmidt, Lane and others have made much use of 
this preparation and have noted excellent results. 
The writer has made use of this remedy in hundreds 
of cases with great success. 

Petroleum oil, as found in its native state, has 
been long used by primitive people and pioneers 
as a remedy for constipation. Arbuthnot Lane 



BATHS AND OTHER HOME TREATMENTS 261 

informed the writer that he had learned from 
authentic sources that petroleum has been used for 
centuries by the Kaffirs, and it is well known that 
it was employed as a domestic remedy in America 
long before it was used for illuminating purposes. 
The oil was found floating upon the waters of cer- 
tain streams, and was collected and sold by itinerant 
peddlers, and occasionally in drug stores. 

Paraffin is not acted upon by any of the digestive 
juices, and is not absorbed. It prevents the drying 
of the feces, lubricates the colon and rectum, and 
also to some extent prevents the absorption of toxins 
from the intestine. It may possibly to some degree 
encourage fermentation by preventing the absorp- 
tion of digesting food stuffs, and in the same way 
may tend to encourage putrefaction. The writer, 
on this account, has found it of use to combine it 
with agar-agar, so as to facilitate intestinal action 
by increasing the bulk of the feces. By the addition 
of some syrup, carbohydrates and concentrated fruit 
juice, honey, or malt syrup, the tendency to putre- 
faction in the colon may be antagonized, and there- 
by any possible evil results avoided. 

Paraffin oil will not remedy every defect in the 
defecating process and hence will not cure every 
case of constipation, but it comes nearer being a 
panacea than any remedy which has heretofore 
been found, and does meet a surprisingly large 
number of indications. After a careful study of 
its effects in several thousand cases, the writer feels 



262 COLON HYGIENE 

justified in saying with much confidence that paraf- 
fin oil may be relied upon to accomplish the follow- 
ing results in the treatment of chronic constipation: 

1. It lubricates the alimentary canal through- 
out its whole length. In a large number of cases 
of constipation there is an excessive absorption of 
water from the colon, leaving the feces dry or pasty 
and adhesive. An examination of the rectum and 
pelvic colon in such cases shows the mucous mem- 
brane to be deficiently lubricated by mucus, and 
covered with flakes of adhering feces. The use 
of half an ounce or an ounce of paraffin oil at bed- 
time, and half as much an hour before each meal, 
will in two or three days change the condition 
completely, as shown by proctoscopic examination. 

2. This mechanical lubricating action of paraffin 
is highly important in overcoming kinks due to re- 
dundance or to adhesions resulting from colitis or 
other causes. When the mucous surface is kept 
well lubricated, the fecal matter slips along and 
easily overcomes mechanical obstacles, which other- 
wise become formidable sources of obstruction. 

3. The human alimentary canal, like that of 
other primates, as illustrated in the diet of the 
higher apes, is adapted to a moderately coarse bill 
of fare. The concentrated diet of our modern 
civilized life contains so little indigestible material 
that the residue forms a pasty mass which tends to 
adhere to the intestinal wall, especially when any 
obstruction is presented by kinks, folds, adhesive 



BATHS AND OTHER HOME TREATMENTS 263 

bands, or a spastic state of the bowel due to colitis. 
When delay occurs, the further absorption of water 
converts these pasty residues into hard masses, scy- 
bala, which sometimes have almost the density of 
wood. Fats of all sorts are more or less laxative 
if taken in sufficient amount, through their effect 
in modifying the character of the food residues. 
They render the mass less adhesive and to some 
extent prevent dryness; but both animal and vege- 
table fats are digestible and absorbable, and hence 
are not to any considerable degree effective in chang- 
ing the character of the stools unless eaten in 
amounts larger than can be used, so that a consider- 
able portion remains behind in the colon. Such 
large quantities of fat encourage putrefaction, lessen 
appetite, diminish the secretion of hydrochloric acid, 
interfere with the motility of the stomach and the 
small intestine, and may produce great disturbance 
of the body metabolism. Paraffin oil is free from 
these objections, since it is wholly non-absorbable, 
and a comparatively small amount serves the pur- 
pose required, because it all remains in the intes- 
tine. 

4. Paraffin is useful in all forms of intestinal 
stasis or stagnation, no matter what the cause, by 
preventing the abnormal drying out of the food 
residue which is the necessary result of too long 
retention in contact with absorbing surfaces. 

5. Another remarkably interesting and useful 
property of paraffin oil is found in the fact that it 



264 COLON HYGIENE 

stimulates activity of the small intestine. Observa- 
tions, in a large number of cases, made by Dr. J. 
T. Case, Roentgenologist at the Battle Creek Sani- 
tarium, have shown that paraffin oil greatly ac- 
celerates the passage of material through the small 
as well as the large intestine. This action is ex- 
ceedingly important in those forms of intestinal 
toxemia which depend upon iliac stasis, by far the 
most serious of all forms of stasis. Stagnation in 
the small intestine is of far greater importance than 
stasis in the colon, for the reason that both putre- 
faction and absorption are much more active in 
this part of the digestive tube than in the large in- 
testine. Even in cases in which iliac stasis is due to 
the so-called Lane's kink, as shown by X-ray ex- 
amination, great relief may usually be obtained by 
the regular use of paraffin. This has been demon- 
strated in many cases. It is only in the most ex- 
treme cases, when adhesions are so extensive that 
the lumen of the intestine is very greatly reduced, 
that surgical measures become necessary. 

6. One of the most interesting features of the 
many-sided useful activities of paraffin, is its be- 
havior toward intestinal toxins. These toxins con- 
sist, not only of bile acids and alkaline wastes of 
various sorts excreted by the intestinal mucous 
membrane, but in addition, of a great variety of 
ptomaines and toxins produced through bacterial 
action, especially in the colon, and also in the small 
intestine in cases of incompetency of the ileocecal 



BATHS AND OTHER HOME TREATMENTS 265 

valve. Paraffin is a highly active solvent, and 
readily dissolves these waste and poisonous sub- 
stances, many of which are more soluble in paraffin 
oil than in water. The result is that the paraffin 
oil, itself not absorbable, takes up a very consider- 
able portion of toxins found present in the intestinal 
tract, and thus prevents their absorption. When 
paraffin is used, it may always be seen in the stools, 
showing a brownish or blackish color, due to the 
substances which it holds in solution. In a labor- 
atory test made by a competent chemist by request 
of the writer, it was found that when paraffin oil 
was shaken with a watery solution of indol, more 
than half the indol was quickly taken up by the 
paraffin. The use of paraffin thus affords an ef- 
fective means of hindering the absorption of in- 
testinal toxins, and conveying them out of the body. 

7. Paraffin oil serves a useful purpose in pro- 
tecting the mucous membrane when it is in an ir- 
ritated state, as in cases of chronic colitis. The 
value of petrolatum and other neutral petroleum 
products as a dressing for wounds is well known. 
Paraffin acts in an equally favorable way upon 
irritated mucous surfaces. It has long been used 
for this purpose in the treatment of diseases of the 
nose and throat. 

8. Paraffin serves another useful protective pur- 
pose in hindering the absorption of poisons by 
mucous surfaces which have been deprived of their 
epithelium. The normal epithelial covering of the 



266 COLON HYGIENE 

intestines has remarkable filtering powers, by which 
toxins, especially colloid poisons, are excluded. 

This filtering power is lost when the surface is 
denuded. A protective layer of oil renders great 
service in such cases, by hindering the absorption 
of these poisonous matters, which occurs with great 
readiness through abraded surfaces. 

9. In cases of colitis, paraffin oil protects the 
irritated surfaces, but also through its lubricating 
effect and through softening the intestinal contents, 
aids greatly in overcoming the spastic condition of 
the intestine, which in many cases of chronic con- 
stipation is so formidable an obstacle to recovery. 
Laxatives of all sorts increase the spasticity of the 
intestine, and so aggravate the constipation which 
they are given to relieve. This is one reason why 
many are more constipated after taking a laxative 
than before. Temporary relief is obtained by the 
production of watery stools which are able to pass 
through the contracted bowel, but as soon as the 
first effects of the laxative pass off, constipation be- 
comes worse than before, since the spasm is greater. 
Paraffin lubricates and protects the sensitive sur- 
face of the spastic bowel, and at the same time 
softens the intestinal contents so as to permit pas- 
sage through the bowel without mechanical irrita- 
tion. Cases of colitis are greatly benefited by the 
regular use of paraffin. 

10. X-ray observations of Case, confirmed in 
many cases at the operating table by the writer, 



BATHS AND OTHER HOME TREATMENTS 267 

have shown that incompetency of the ileocecal 
valve is a most common and effective cause of iliac 
stasis. Experience in treating several hundreds of 
cases have shown that, aside from the regulation 
of diet, and the use of bran and agar-agar, the 
regular use of paraffin oil is the most effective 
means of combating this condition. Medicinal 
laxatives increase the antiperistalsis by which the 
reflux from the colon into the small intestine is 
increased. Case has shown by X-ray examination 
that paraffin increases the motility of the small in- 
testine, while it does not increase antiperistalsis. It 
is thus a rational and efficient remedy of great value 
in dealing with this very large and important class 
of cases. 

11. In all cases in which the stagnation of the 
small intestine is due to spasm of the ileocecal valve, 
induced by chronic appendicitis, ovarian irritation 
or inflammation, colitis, or possibly painful rectal 
disease through reflex irritation, paraffin proves it- 
self to be an invaluable remedy, since it has the 
property of increasing the peristaltic activity of the 
small intestine to such a degree as to enable it to 
overcome the spasm of the ileocecal valve without 
producing irritation, which would inevitably in- 
crease the spasm of the sphincter, as do drug laxa- 
tives. The neutral character of paraffin, which 
enables it to stimulate and facilitate intestinal mo- 
tility without producing irritation, is invaluable. 

12. The regular use of paraffin oil very generally 



268 COLON HYGIENE 

relieves hemorrhoids and fissure, even when of 
some years' standing. These morbid conditions 
are usually the result of constipation, and are main- 
tained and aggravated by straining at stool. By the 
habitual use of paraffin, the stools are made soft, 
straining is avoided, the intestinal contents are ren- 
dered less irritating and infectious, and thus the 
diseased tissues are readily healed. 

Since adopting the use of paraffin, the author has 
found that the number of cases in which operation 
for hemorrhoids is needed is greatly reduced. Pa- 
tients who have contemplated submitting to opera- 
tion for removal of hemorrhoids of many years 5 
standing, in a short time after beginning the use 
of paraffin, often find themselves so completely re- 
lieved that an operation is no longer necessary 

13. Paraffin is capable of rendering invaluable 
service in cases of intestinal intoxication, by increas- 
ing the number of daily stools. The length of 
time which foodstuffs remain in the intestine is 
reduced from several days to a few hours. This 
greatly lessens the opportunity for development 
of putrefactive processes and the absorption of 
putrefaction products. It may be justly said that 
no other remedy is capable of rendering such im- 
portant and efficient service in combating constipa- 
tion as this simple and harmless agent; but it must 
be continuously, a proper dose (one or two table- 
spoonfuls) at each meal. 



BATHS AND OTHER HOME TREATMENTS 269 

Objectionable Features of Paraffin 

The few unpleasant effects attending the use of 
paraffin are really so slight in character that they 
are generally easily overcome. Sometimes, how- 
ever, they constitute a real obstacle to the use of this 
most valuable remedy. The chief objections which 
are met are the following: 

1. An unpleasant oily taste which to some peo- 
ple is so disagreeable as to produce nausea and loss 
of appetite. 

2. A disposition to separate from the other intes- 
tinal contents. It usually appears as a brown oily 
liquid separated from the rest of the stool and 
sometimes the separation is so marked that the stools 
are very ragged, or consist of hard lumps smeared 
with brown oil. 

3. Paraffin oil is so limpid that it readily finds 
its way to the rectum ahead of the other bowel 
contents, and very easily escapes, either with or 
without the expulsion of flatus. The patient is often 
unconscious of the escape until it is noted that the 
clothing is badly soiled. 

The difficulty of taking paraffin the writer suc- 
ceeded in overcoming almost entirely by preparing 
a very heavy emulsion through the assistance of gum 
acacia. This emulsion is easily taken in hot or cold 
weather, but is open to the objections raised under 
two and three. 



270 COLON HYGIENE 

Paraffin Tablets 

All objections are removed by the use of paraffin 
in solid form. Paraffin tablets which are solid at or- 
nary temperatures, but melt at the temperature of 
the inside of the body, are easily taken with the 
food. Paraffin in this form mixes with the feces 
thoroughly and does not separate. A single tablet 
(one-half ounce) is sufficient for a dose. One tab- 
let is taken with each meal. Two or more tablets 
may be taken without injury. 

Lubrication of the Rectum 

In many cases of chronic constipation the lower 
colon and the rectum become dry, the result of 
atrophy of the lubricating mucous glands which 
have been destroyed by colitis or chronic proctitis. 
This condition may extend up into the pelvic colon. 
As a result, the feces adhere to the walls of the 
bowel and so accumulate, forming impactions and 
cumulative constipation, one of the most frequent 
forms of constipation. In many such cases only 
partial relief is obtained by a laxative diet. By the 
use of paraffin oil, one or two tablespoonfuls before 
each meal, the colon and rectum may be lubricated 
artificially. In some cases, further lubrication is 
needed. For this purpose there is nothing so useful 
as a specially prepared paraffin which melts at a 
temperature of 102° F., or just above the body 
temperature. This is heated until it is nearly all 



BATHS AND OTHER HOME TREATMENTS 271 

melted, by placing the container in hot water. Then 
with a piston syringe three or four ounces of the 
warm melted paraffin is introduced into the rectum. 

To enable the paraffin to reach the pelvic colon 
the patient should assume the knee chest position 
for two or three minutes after the paraffin is intro- 
duced and should take deep breaths to encourage 
the distribution of the melted oil. 

The temperature of the body being about 100° 
F., or less than that of the paraffin, the latter will 
be cooled below its melting point, and so will ac- 
quire the consistency of a soft ointment which ad- 
heres to the surface of the bowel, and serves as a 
most efficient lubricant. 



Exercises Which Combat 
Constipation 

The exercises that are of the greatest value in 
cases of constipation are those which bring into 
strong action the muscles of the abdomen. The 
abdominal muscles are generally weak and relaxed, 
and the intra-abdominal pressure is consequently 
low. 

By appropriate exercises the weak muscles may 
be strengthened; the intra-abdominal pressure may 
be raised, and the colon may be thus enabled to 
contract with sufficient impetus to expeL its con- 
tents. 

Hill Climbing 

Hill climbing is a more valuable exercise than 
walking on the level, because the abdominal muscles 
are brought into more active play. When moun- 
tain climbing is not an available form of exercise, 
nearly the same results may be obtained by climb- 
ing a ladder or by walking up and down stairs. 
The writer has also made use of the treadmill as 
the means of securing muscular exercise similar to 
lhat required in hill climbing. 

272 



EXERCISES FOR CONSTIPATION 273 

Horseback Riding 

Horseback exercise is especially indicated as an 
exercise for constipation. Riding a considerable 
distance, however, is necessary to produce any de- 
cided effect, as, on the whole, horseback riding to 
a person accustomed to it, is not very active exer- 
cise, except when riding a hard trotting horse. 

Rowing 

Rowing is one of the very best exercises to com- 
bat constipation, provided the chest is held high 
during the exercise, and especially if care is taken 
to give the trunk as strong a backward movement 
as possible; but care must be taken to avoid holding 
the trunk forward with the shoulders rounded and 
the chest depressed. 

Tennis 

Tennis may be highly commended for young 
persons and those who are sufficiently strong to 
engage in this form of exercise without injury, 
This very popular game is, however, too vigorous 
for persons with weak hearts. 

The Medicine Ball 

This is a capital exercise for persons who are 
fairly strong. It brings the muscles of the trunk 
into vigorous action. 



274 COLON HYGIENE 

Work Exercise 

The movements of chopping and digging, swing- 
ing the hammer and mowing are highly valuable 
exercises if taken with due care to maintain the 
body in an erect position. Many household occu- 
pations, such as scrubbing, washing, and general 
housework, are execellent forms of exercise when 
correct posture is maintained. 

Posture 

Of first importance to persons suffering from 
constipation is the maintenance of an erect position 
of the trunk. When the chest is lowered, as in 
sitting in a relaxed attitude, the distance between 
the breast bone and pelvis is diminished so that the 
large muscles, which form the front of abdominal 
wall are shortened and relaxed. In this attitude 
the muscles cannot be contracted sufficiently to pro- 
duce the proper degree of intra-abdominal pressure. 
When the chest is held high, the rectus muscles are 
stretched and are thus able by contraction to pro- 
duce the maximum effect in compressing the colon. 
Flat-chested persons are predisposed to constipation 
because of inefficient action of the abdominal 
muscles. 

The ordinary chair must be regarded to a very 
considerable degree as responsible for the prevalence 
of flat chest and round shoulders, and the evils 
which result from this deformity. It is possible to 




Incorrect Standing Position 







Getting Correct Standing 
Posture (First Position). 



Method of Getting Correct 
Standing Posture (Second Po- 
sition)- 





Getting Correct Standing Correct Standing Posture 
Posture (Third Position) 



EXERCISES FOR CONSTIPATION 275 

sit in an erect attitude in a chair of any shape; but 
with a chair with a straight back, constant effort is 
required, by forcible contraction of the muscles, to 
maintain the body in an erect position. The moment 
the muscles are permitted to relax, the trunk falls 
into an abnormal and unhealthy attitude, the spinal 
column being curved backward instead of forward, 
as is natural and necessary for health. This will 
readily be understood by reference to the accompany- 
ing cuts. 

As the result of an habitually wrong attitude in 
sitting, the same improper attitude is maintained 
when standing and walking, and the figure becomes 
deformed. A flat chest, round shoulders, and a 
forward carriage of the hips are characteristics to 
be found in the great majority of persons who lead 
sedentary lives, especially those who sit much at 
their work, such as accountants, writers, teachers, 
and professional people generally. One of the first 
things, then, for a constipated person to do is to 
correct his sitting and standing attitudes. This 
may be done by careful execution of the following 
exercises, which the writer has employed for more 
than 25 years with much satisfaction in the treat- 
ment of cases of this sort. 

To Correct the Standing Posture 

Stand against a straight wall. Place heels, hips, 
shoulders, head and hands firmly against the wall. 



276 COLON HYGIENE 

Now bend the head backward as far as possible, 
or until the eyes look straight up to the ceiling, at 
the same time permitting the chest and shoulders 
to move forward. While holding the head in this 
position, press the hands firmly against the wall; 
draw the chin down to position without allowing 
the shoulders to move backward ; still holding the 
body rigid, allowing the arms to fall at the sides. 
In this position the chest will be held high and the 
abdominal muscles well drawn in. While holding 
this position execute movements with the arms ; 
arm raising above the head, swimming movements, 
etc. 

This is the correct standing position and should 
as far as possible, be constantly maintained in stand- 
ing and walking. It is impossible, of course, to 
hold the muscles constantly rigid. In relaxing, 
however, care should be taken to keep the chest 
forward, so that the body does not fall back into 
the former incorrect attitude. 

Exercises to Correct the Sitting Posture 

Sitting upon a chair or stool, preferably the latter, 
proceed as follows: 

Place the hands on the hips, with the thumbs 
behind. Bend the head backward so as to look 
straight up to the ceiling; now bend forward as far 
as possible while still keeping the eyes on the ceiling; 
now make firm pressure with the thumbs, and while 



EXERCISES FOR CONSTIPATION 277 

pressing hard bring the body up to the erect position. 
Still keeping the eyes upon the ceiling, holding the 
elbows as far back as possible, and without for an 
instant lessening the pressure on the thumbs, bring 
the chin down to position. 

If this movement is executed according to direc- 
tion, it will bring the body into perfect position, 
with the chest raised high and the abdominal mus- 
cles well drawn in, as shown in the accompanying 
cut. To secure definite and beneficial results it is 
necessary to use a chair having a back of the right 
shape as shown in the accompanying illustration. 

Breathing Exercise 

Sit with the hands at the back of the neck, and 
the elbows in line with the shoulders, the chest 
held high, and the abdominal muscles well drawn 
in. Raise the heels and make rapid movements 
upon the floor with the toes for one minute. Then 
take ten deep breaths, still holding the arms in posi- 
tion. 

Rocking Chair Exercise 

Sitting upon the front edge of a chair, with the 
hands upon the hips, the thumbs behind, the elbows 
well drawn back, bend forward to an angle of 45° 
and then, holding the body rigid, throw the trunk 
backward, lifting the feet clear of the floor. Repeat. 
The effect wiii be a rocking movement. Breathe 



278 COLON HYGIENE 

deeply. Repeat forty times. A rocking chair may 
be conveniently used in taking this exercise. 

Exercise to Raise the Chest 

Lie upon the back on a hard surface; place be- 
neath the hollow of the back a roll of blankets or 
a folded pillow or cushion about six inches in 
diameter. The purpose of this is to give the spinal 
column the forward curve which is natural to it, 
and thus to raise the chest. The roll should be 
placed at such a point as to raise the chest to the 
fullest extent, while the head and shoulders still 
rest upon the couch. In this position, deep breath- 
ing movements should be practiced at the rate of 
about ten a minute. 

To Strengthen the Abdominal Muscles 

With the back supported as in the previous 
paragraph, raise both legs to the perpendicular. 
Repeat ten to forty times. A deep breath should 
be taken just before the legs are raised, and after 
each movement there should be a pause during 
which a deep breath is taken. 

Feeble and very fleshy persons are often at first 
not able to raise the legs. In such cases the exer- 
cise will begin with the legs drawn up to a fixed 
position. By extending the legs and allowing them 
at the same time to drop slowly to the starting 
position, the abdominal muscles may be brought 



EXERCISES FOR CONSTIPATION 279 

into strong contraction, and as they gradually in- 
crease in strength, the legs may be flexed less until 
they can be raised to a vertical position without 
flexion. 

Trunk Raising Exercise 

Lying on the back and holding the legs firmly 
extended, raise the arms forward and raise the body 
to the perpendicular, then bend forward, and, if 
possible, touch the toes. Repeat ten to twenty 
times. 

Rolling Exercise 

Rolling over on the floor or on a wide bed is a 
capital exercise for strengthening the lateral muscles 
of the trunk. Practice for five minutes. 

» 

Rocking Exercise, Lying 

Flex the left leg upon the abdomen; clasp the 
hands beneath the knee and pull as hard as pos- 
sible, so as to force the thigh down upon the ab- 
domen; then, with the other leg fully extended, 
cause the body to execute rocking movements by 
quickly moving the leg up and down, assisting by 
forward and backward movements of the head 
Repeat same with the right leg. This is a very ef- 
fective exercise if taken vigorously and repeated 
three times a day for five or ten minutes. 



280 COLON HYGIENE 

Arm and Trunk Exercise with Deep 
Breathing 

Standing with the chest held high, place left hand 
upon the left hip. With a swinging movement 
outward bring the right arm to the perpendicular, 
and then holding the arm in position, bend the 
body to the left side as far as possible, breathing 
in. Rise to position, breathing out. Repeat four 
times and then execute the same movement with 
the right hand upon the hip, breathing in. 

Squatting Exercise 

Standing, with the heels separated ten or twelve 
inches, the hands upon the hips, execute squatting 
movements, bringing the trunk as near to the floor 
as possible, and bending slightly forward. An 
excellent exercise to stimulate bowel movement. 

Running on All Fours 

With arms and legs extended run about the 
room for five or ten minutes. Running on all fours. 
This movement was prescribed by a Berlin physician 
for an eminent German Statesman, with excellent 
results. 

Knee-Chest Breathing 

Placing the body in the knee-chest position, ex- 
ecute deep breathing movements, filling the chest 



EXERCISES FOR CONSTIPATION 281 

as completely as possible, then, holding the chest 
in position, draw in the abdomen as much as pos- 
sible while breathing out. 

Colon Compressing Exercise 

Sitting on a low seat or with the feet raised upon 
a stool, place the closed fists in the left groin and 
bend the trunk strongly forward so as to com- 
press the hands between the thighs and the abdo- 
men. Take several deep breaths while holding the 
body in this position. 

Inclined Plane Exercises 

Among the most important of all forms of ex« 
ercises for combating constipation, series of certain 
simple exercises are taken upon an inclined plane P 
with the head low. The special advantages of the 
inclined plane are: 

1. The head-low, hips-high position greatly 
aids in the replacement of the prolapsed stomach 
and colon, conditions almost universally present 
in chronic constipation. 

2. The head-low position drains the abdomen 
of blood, thus relieving congestion of the viscera* 

3. Exercises of the trunk muscles should always 
be taken after the prolapsed viscera have been re- 
stored to position. When this is not done, the ef- 
fect may be to increase the displacement whenever 
the abdominal muscles are strongly contracted. 



282 COLON HYGIENE 

There are three classes of exercises to be taken 
with the inclined plane, viz : ( 1 ) Stretching ex- 
ercises, (2) Colon replacing exercises, and (3) 
Trunk exercises. 

The folding exercise table is a convenient ap- 
pliance for use in these exercises. It may be in 
part replaced by an ordinary ironing board placed 
with one end resting upon the side of a bed, couch 
or window sill, the other on the floor. The ex- 
ercise table is provided with a strap at one end 
to hold the feet and prevent slipping down and a 
rope with handle attached for pulling the body 
up. At the sides are placed handles to be grasped 
by the patient. 

Getting in Position 

The following is a convenient method of plac- 
ing one's self in position upon the table: Standing 
upon the left side of the table grasp the strap with 
the right hand. Sit down upon the table and 
swing up one foot and place it under the strap 
and then bring up the other foot in the same way 
and then grasp the sides of the table or the handles 
and let the trunk fall down into position. While 
an ordinary ironing table may be used, the strap for 
the feet and the handles for the hands are really 
essential for convenient use. 

After getting into position upon the table, the 
patient takes a few very deep breaths, holding the 
chest high while breathing out. 






The Exercise Table 



EXERCISES FOR CONSTIPATION 283 

Exercises 

Grasping the handles, bend the head backward 
as far as possible, at the same time widely opening 
the mouth as in yawning. 

Position 

Patient lies upon an inclined table grasping the 
handles. (a) Right arm, left leg stretch. (b) 
Grasping handle with left hand raise the right arm 
above the head and at the same time point the toe 
of the left foot and reach as far as possible in oppo- 
site directions, (c) Do the same with the left arm 
and right leg. 

Colon Replacing Exercises 

Lying on the inclined table with feet under the 
strap, place the hands upon the lower abdomen and 
breathe deeply; with each expiration press hard 
upon the little-finger side of the hands and draw 
the hand upward so as to push the contents of 
the abdomen toward the diaphragm. Hold the 
hands firmly in position during the inspiration. 
Repeat ten or twelve times. 

Abdominal Compression-Breathing 

Compress the abdomen firmly with the hands 
and take a slow deep breath. Repeat fifteen or 
twenty times. 



264 COLON HYGIENE 

Diaphragm Exercise 

Lie upon the face over a folded pillow or 
cushion with the feet under the strap and the head 
resting upon the folded arms. Take deep breaths. 
This is an exercise for relieving congestion of the 
abdominal viscera, strengthening the breathing 
muscles. At each breath the diaphragm is com- 
pelled to lift the weight of the trunk. 

Exaggerated Knee-Chest Breathing 

Grasping the handles, rise from the position of 
the preceding exercise to a kneeling position, push- 
ing the pillow forward a little and then take the 
knee chest position; take ten to fifty deep breaths. 
This is a most effective means of draining the over- 
filled blood-vessels of the abdomen and pelvis, and 
sets gravitation to work pulling the prolapsed or- 
gans into position. The exercise is still more effec- 
tive if taken after filling the colon with water, as 
the added weight of the prolapsed organ assists in 
restoring it to position. 

Leg Raising 

Lying on the back, hands grasping the handles, 
while holding both legs straight and toes pointed, 
raise them to vertical position while counting four. 
Lower at the same rate. Repeat eight to twelve 



EXERCISES FOR CONSTIPATION 285 

times, taking one or two deep breaths after each 
movement. 

Trunk Twisting 

Back lying, feet under strap, throw the extended 
right arm over to the left, at the same time turning 
the face and shoulders in the same direction. Re- 
turn to position, and repeat eight or ten times. Do 
the same with the left arm. 

Hips Rolling 

Back lying, draw the knees up as far as possible, 
then extend the limbs vigorously as far as pos- 
sible toward the left, rolling the body in the same 
direction. When the legs are completely extended, 
carry them straight across to the opposite side, roll- 
ing back toward the right side. Complete the 
movement by drawing the legs back to the flexed 
position and returning to the starting position. 
Repeat ten or twelve times, pausing long enough 
after each movement to take one or two deep 
breaths. This is a most excellent exercise for all 
the muscles of the trunk. 

Static Exercises 

These are exercises which may be taken while 
one is engaged in study, writing, book-keeping, or 
some sedentary occupation, without interfering 
with the work in hand. The purpose being to 



286 COLON HYGIENE 

combat the pernicious effects of any form of con- 
fining work. 

With the chest held high, the abdominal mus- 
cles well drawn in, and the body supported in a 
correct posture, deep breathing may be practiced 
with most excellent results. The breathing may 
often be made rhythmical with the work, especially 
in typewriting, adding and similar work which is 
more or less mechanical in character. In this way 
exercise may become a means of increasing efficiency 
directly, as well as through better aeration of the 
blood and the resulting improvement in mental and 
physical activity. 

This deep breathing may be practiced under al- 
most any conditions without interfering with the 
work in hand. When riding on the street cars or 
in an automobile, even when sitting in church or 
at a lecture, deep breathing may be practiced al- 
most continually. The practice will be found to 
promote bowel activity, and to enormously increase 
efficiency and endurance. When the habit is once 
formed the deep breathing becomes automatic. 
Typists, printers, and persons engaged in similarly 
unhealthful occupations may, by this means so 
strengthen their resistance, and maintain such a 
high state of vital efficiency, that they may possibly 
escape the dreaded pulmonary tuberculosis, the 
malady above all others that is the most fatal to 
this class of workers. 



EXERCISES FOR CONSTIPATION 287 

Tension Exercises 

During life the muscles are always in a state of 
tension; that is, every muscle is more or less active 
even when it seems to be at rest. This tension is 
increased by cold to the point of producing visible 
movements of shivering. It is also increased by 
pain or jnflammation, as is seen in the rigid con- 
traction of the abdominal muscles in appendicitis- 
Tension may also be increased by a simple effort 
of the will. The mere thinking of a bodily move- 
ment, in fact, increases the tension of the muscles 
which are concerned in the movement, and to such, 
a degree that long-continued fatigue may result, 
showing that work has been done, as when one 
watches the performance of acrobats, or a closely 
contested athletic game. This fact may be made 
of practical value. Thus if one's feet are cold, they 
may be quickly warmed by alternately tensing and 
lelaxing the muscles of the legs, or by making slow, 
tense, flexion and extension movements of the feet. 

In like manner all the muscles of the legs may 
be brought into active play by simply setting or 
tensing the muscles of the legs that is, holding the 
limbs rigid with as much force as possible. The 
muscles of the trunk and arms may be tensed in 
like manner. All the muscles may be tensed at 
once, or different sections as arm muscles, trunk 
muscles, or the muscles of a single limb may be 
exercised in succession. Tension exercises may be 



288 COLON HYGIENE 

taken in may cases without the slightest interfer- 
ence with one's work; and when the work is very 
sedentary one may by this means, without loss of 
time, secure a large part of the benefit of such ac- 
tive exercises as walking, tennis, playing, etc. Such 
exercises should not be considered as a substitute, 
however, for out-of-door exercise, but rather as a 
supplement to such exercise. 

One very excellent form of exercise which may 
be taken while sitting at desk at work or when 
reading or studying is rapid raising or lowering 
of heels, either together or in alternation. The heels 
are raised so that the weight of the limbs rests on 
the toes, and the limbs are then set in rapid mo- 
tion. Bracing the feet together, a similar move- 
ment may be executed with the knees rapidly sepa- 
rating and closing. The movement is so rapid that 
the exercise closely resembles shivering. 

One excellent use for movements of this kind 
is to prevent taking cold when one is exposed to 
a draft. If, for example, one feels a draft of cold 
air on the back of the neck, he may prevent ill 
effects by simply tensing muscles of the neck, or 
indeed, by holding the muscles rigid while making 
slow movements of the head, either forward and 
backward or side-wise. In out-of-door sleeping, 
exercises of this sort may be resorted to as a means 
of warming the feet and limbs. These warming 
exercises are important for persons suffering from 
constipation, because of the tendency that such 



EXERCISES FOR CONSTIPATION 289 

persons have to coldness of the extremities, the 
result of spasm of the blood vessels, due to the 
influence of intestinal poisons upon the vasomotor 
centers. 

Special Means to Aid Defecation 

The general aim of all the exercises given in 
this book is to aid defecation by strengthening the 
muscles of the trunk and abdomen, and forming the 
breathing movements. There are special exercises 
which may be employed during defecation which 
render effective aid in evacuation of the bowels. 

The natives of India, as mentioned elsewhere, 
aid evacuation when the bowels are constipated by 
pressing a ball formed by a folded cloth upon the 
lower left side of the abdomen. Many consti- 
pated persons have found by experience the advan- 
tage of pressing upon this part of the abdomen with 
one or both closed fists, during defecation. 

Persons who have very relaxed abdominal walls 
often find it very advantageous to compress and 
knead the abdomen during defecation, especially 
upon the left side. A medicine ball may be used 
for the purpose. The ball is held firmly against 
the abdomen, the under side resting on the separated 
thighs. By bringing the thighs together at the 
same time pressing with the hands, the ball is forced 
against the abdomen. The abdomen may in this 
way be compressed with considerable force. The 
closed fist may be used in place of the ball. 



290 COLON HYGIENE 

An Exercise Program 

When possible exercise shuuld always be taken 
in a rhythmical way. This effect may be secured 
by means of counting, or better still by the aid ©f 
music, for which a phonograph, victrola or a graph- 
aphone serves an excellent purpose. 

The following is an excellent program of ex- 
ercises for a person of average strength: 

1. On rising, take an exercise bath (see page 
242), beginning with the water at a temperature 
of 90 degrees and ending at 70 degrees to 60 degrees 
or pipe temperature. Row 100 to 200 strokes 
counting. 

2. Inclined plane breathing and replacement 
exercises. (See page 281.) 

3. Inclined plane exercise to strengthen ab- 
dominal muscles. (See page 282.) 

4. Special exercise to aid defecation. (See 
page 289.) 

After exercise make an attempt to move the 
bowels if a movement has not already been se- 
cured. 

Abdominal Massage 

Before beginning the treatment of any case of 
constipation by massage, a careful study of the 
case should be made, so that the causes of the con- 
dition present may be well understood. Such an 
examination requires, in serious cases, at least an 







Kneading the Colon 



EXERCISES FOR CONSTIPATION 291 

j£-ray examination with a bismuth meal. The bis- 
muth enema must also be administered to show the 
condition of the colon and of the ileocecal valve. 
A radiogram of the colon or at least a tracing made 
by the aid of the X-ray, showing the position, size 
and form of the different portions of the colon is 
of greatest service. With the radiogram and such 
a sketch of the colon at hand, the masseur can make 
his applications with such a degree of accuracy 
as to effect a maximum amount of good with a 
minimum degree of effort, and without wearying 
his patient needlessly. The following methods of 
colon massage are described at greater length in 
the author's work on massage.* 

Massage of the Cecum 

In cases in which there is stagnation of the fecal 
matters in the cecum and ascending colon, massage 
should be applied, with the patient's hips elevated 
to an angle of about 45°. Deep kneading move- 
ments should be made from below upwards, work- 
ing along the colon in the direction of the lower 
ribs of the right side. When the liver is reached, 
the kneading movements should be carried across 
the body in the direction of the transverse colon. 
The hips of the patient should then be lowered, and 
the kneading movement should be directed down- 

* ,- The Art of Massage." Published by Good Health Pub. Co 
Battle Creek, Michigan. 



292 COLON HYGIENE 

ward along the descending colon, starting from 
high up on the ribs of the left side. When the upper 
border of the hip bone is reached, the movement 
should follow the inner surface of the bone to the 
pelvis. Not infrequently the colon is found in a 
contracted or spastic state when it feels like a rub« 
ber tube and may be rolled under the fingers. It 
is usually sensitive to pressure. When the pelvic 
colon is enlarged, it may also sometimes be felt, 
though not infrequently when it is distended with 
feces it lies so low in the pelvis that it cannot be 
reached. By putting the patient in a knee-chest 
position, and executing deep-breathing movement? 
while making deep pressure with one hand on each 
side just above the groins, the pelvic colon can 
sometimes be lifted out of the pelvis, so that it can 
be brought within reach, and the hard masses with 
which it is filled may be broken up. In this region 
the colon will often be found filled with masses of 
hardened feces. 

After careful manipulation of the contracted 
colon for a few minutes it will dilate, the spastic 
condition disappearing for the time being. The 
writer has often noticed this in making examina- 
tions of the colon. Harsh manipulations are likely 
to produce the opposite effect increasing the spasm 
This fact has led some authors to forbid massage 
altogether in cases of colitis, but this is quite 
wrong. Massage is highly beneficial in these 
cases but the manipulations must not be too severe, 




Vibrating Chair 



EXERCISES FOR CONSTIPATION 293 

Mechanical Kneading and Vibration 

Mechanotherapy is capable of rendering more 
service in constipation than in any other single con- 
dition. 

The mechanical applications which are of 
greatest service are kneading and vibration. Sev- 
eral mechanical kneaders have been devised. The 
one shown ip the accompanying cut the writer has 
had in use for more than twenty years, and with 
satisfactory results. Patients generally realize im- 
mediate benefit from the use of the kneader, which 
may be employed for fifteen or twenty minutes 
twice a day, an hour after breakfast, and an hour 
or two after dinner. 

The apparatus consists of six kneading arms at- 
tached to eccentrics, arranged in such a way as to 
be brought to bear upon the abdomen in consecutive 
order. The surface upon which the patient rests 
is at the same time moved to and fro in such a way 
that the kneading movement travels in a series of 
circles round the abdomen. The vigor of the appli- 
cation can be regulated at will. 

There are vibrators of various kinds in use. The 
majority, however, are possessed of too little power 
to be of service in the treatment of the abdomen. 
The best for this purpose are the dumb-bell vibrator 
and the vibrating chair. Hill's dumb-bell vibrator 
has the advantage that it is heavy enough to com- 
press the abdomen to a sufficient degree; and the 



294 COLON HYGIENE 

power of the apparatus is sufficient to give the 
whole abdomen an active vibratory movement. It 
has been proved that these vibratory movements 
induce peristaltic action, while at the same time the 
weight of the instrument increases the abdominal 
pressure, and tends to fix the parts to which the 
application is made, so as to secure a maximum de- 
gree of effect. 

The vibrating chair aids bowel action both by 
directly exciting the centers of the spinal cord and 
by stimulating the lower bowel. The use of the 
cliair for ten or fifteen minutes will in many persons 
develop a lively "call" for bowel movement. 

Self-Kneading of the Bowels at Stool 

In many cases of cumulative constipation the 
chief trouble is in the pelvic colon. This loop of 
intestine, usually about a foot in length, and possess- 
ing thick muscular walls, becomes sometimes so 
enormously stretched and attenuated by accumula- 
tions of fecal matters and gas that its walls are 
weak and contract very feebly, and it is no longer 
an efficient instrument for forcing the feces into 
the rectum, and thus inducing the defecating reflex 
by which the bowel is normally emptied. In such 
a case the patient may sometimes assist himself by 
placing the hand at the lower part of the abdomen 
on the left side and making deep pressure with the 
tips of the fingers, or placing the fist between the 



EXERCISES FOR CONSTIPATION 295 

thigh and the abdomen so as to compress the pelvic 
colon. Kneading of the iliac colon, which lies in 
the hollow of the left iliac bone, is also useful. 

The Cannon Ball 

The cannon ball is a rather old-fashioned but 
useful means of self treatment, by which the pa- 
tient may apply massage to the colon in a very 
efficient way. A small cannon ball weighing about 
twenty or twenty-five pounds is rolled along the 
course of the colon from the cecum toward the 
rectum. The patient should lie with the shoulders 
slightly elevated so as to relax the abdominal mus- 
cles as much as possible. 

The cannon ball should be applied daily soon 
after breakfast, or a little before the time at which 
the bowels are most likely to move. The chief ben- 
efit to be derived from the cannon ball is to aid 
in propelling into the rectum from the pelvic colon 
a sufficient amount of fecal matter to awaken a 
lively stimulation of the defecating center, and so 
to secure a strong impulse and a full evacuation of 
the colon below the splenic flexure. 

The Weighted Compress 

This consists of a thick flannel compress between 
the folds of which is quilted in a considerable quan- 
tity, say fifteen to twenty-five pounds, of lead shot. 
The compress should be large enough to cover the 



296 COLON HYGIENE 

entire abdomen. It should be applied for an hour 
before time for evacuation of the bowels, deep 
breathing movements being executed in the mean- 
time at the rate of twelve to sixteen per minute. 

The Shot Bag 

This device has essentially the same purpose as 
the preceding, but may be applied in such a way 
as to secure a more pronounced local effect; as, for 
example, to force stagnating material out of the 
cecum or the iliac colon. It may, in some cases, 
also be of service in forcing feces from the pelvic 
colon into the rectum, when the pelvic loop has 
been weakened by excessive overloading and dis- 
tention with gas. The usual weight of the shot 
bag is twenty to twenty-five pounds. It should 
be placed over the spot where the accumulation 
can be felt with the fingers or seen with the X-ray 
and should be left in place for an hour, while deep 
breathing movements are practiced at the rate of 
twelve to sixteen per minute. 

This simple measure has the advantage that it 
may be used by the intelligent patient at his home, 
and its use may be continued for an indefinite time 
without injury, which cannot be said of any drug 
remedy. All drugs which act by irritating the in- 
testine, sooner or later, usually sooner, produce 
colitis and other disorders. There are no harmless 
drugs. Of course this does not apply to such purely 
mechanical and harmless means, as bran and paraffin. 




Relaxed protuberant ab- 
domen, a result of bad sit- 
ting position. 



The same person stand- 
ing, poise corrected and ab- 
domen held up by a spring 
supporter. 



EXERCISES FOR CONSTIPATION 297 

Pneumatic Compression of the Abdomen 

Compression of the abdomen by an inflated rub- 
ber bag is a measure of value, of which the writer 
has made use for some years. On one occasion, 
a patient who seemed dead from surgical shock was 
restored almost instantly by placing a rubber bag 
under an abdominal bandage and inflating it as 
fully as possible. The face, which had become 
ashen gray, while the heart had ceased to beat, at 
once became flushed with the color of health, the 
heart began to beat, the patient began breathing, 
and death was averted. This observation showed 
the effect of abdominal compression applied in this 
way, and suggested the use of the same means to 
increase the intra-abdominal tension as an aid to 
bowel movement. In using the bag for this pur- 
pose, it must be tightly compressed by means of a 
stout bandage, and must be large enough to cover 
the whole abdomen, so that when inflated it will 
well fill the abdominal cavity, pressing before it 
the relaxed abdominal wall. 

The compression bag is of special service in cases 
in which the abdominal muscles are very greatly 
relaxed, as in women who have borne a number 
of children, and whose muscles have not been well 
developed. It is most applicable to those who have 
not a superabundance of fat, especially those who 
have lost much in weight after having been over- 
fat. 



298 COLON HYGIENE 

The Abdominal Supporter 

While compression of the trunk at the waist is 
always harmful, compression and support of the 
lower abdomen is of great service in many cases, 
because of the unnatural feebleness of the abdom- 
inal muscles. In fleshy patients almost any sort 
of bandage will accomplish good, but in thin pa- 
tients an ordinary bandage is of little use, for 
the reason that it is held out in front by edges of 
the iliac bones, and so does not press with sufficient 
firmness upon the lower abdomen where support is 
needed. 

The most effective support in such cases can be 
secured only by a bandage which is compressed by 
springs. Such a bandage, which the writer has 
had in use for more than a dozen years, is shown 
in the accompanying cut. In fleshy patients a 
stout bandage made of ducking and cut to fit 
snugly is of greatest service. 

The bandage must be worn constantly when 
the patient is on his feet. Its purpose is not simply 
to support the viscera, which the best of bandages 
can do only in a very small degree, but to increase 
the intra-abdominal pressure to such a degree as to 
assist the colon in disposing of its contents. Some 
oatients are completely relieved of constipation by 
the use of a proper bandage. 

In most cases it is necessary to employ perineal 
bands to keep the bandage in position at the lower 
abdomen, where alone it can be of service. 



EXERCISES FOR CONSTIPATION 299 

Pain in the back is one of the disagreeable symp- 
toms which an efficient bandage often relieves, es- 
pecially when the pain is due to enteroptosis, or 
prolapse of the intestines, rather than colitis. 

A sense of exhaustion, often resulting from low 
intra-abdominal tension, which permits an undue 
amount of blood to accumulate in the abdominal 
vessels, robbing the brain and spinal cord, is almost 
immediately relieved by a proper bandage. 

The bandage is only a palliative, however, and 
its use must be accompanied by the development 
of the abdominal muscles by means of massage, 
electricity, and suitable exercises. 

In cases requiring the use of the abdominal 
supporter during the day, the moist abdominal girdle 
should be worn at night to aid in relieving con- 
gestion. The bandage should be used with the 
mackintosh protection, and the bandage should be 
removed or renewed before it becomes dry. 



Efficient Electrical Methods 

While electricity is certainly not a panacea for 
constipation, nor for any other disease, and is cer- 
tainly not able to accomplish a tithe of the miracles 
which have been attributed to it, it is neverthe- 
less, when skillfully applied, a most valuable remedy 
in constipation. As ordinarily used by means of 
sponges held in the hands, and employing a current 
from a small buzzing faradic machine, nothing 
more is accomplished than a slight titillation of the 
skin and giving the patient a slight amount of 
pain, which may, however, in some cases, exercise 
a beneficial psychological effect. 

Electricity may render valuable service in con- 
stipation in two ways : ( 1 ) By inducing automatic 
exercise of the abdominal muscles and so restoring 
their tone and strength; and (2) by stimulating 
the colon itself and thus inciting bowel action, and 
(3) by restoring lost nerve sensibility to the rectum. 
This it does both by directly exciting bowel action 
and by raising to activity sensibility of the rectum 
when lost by neglect. 

Automatic Exercise 

Automatic exercise of the abdominal muscles 
may best be administered by the aid of the nim- 
soidal electrical current. The static farradic cur- 

300 



EFFICIENT ELECTRICAL METHODS 301 

rent may be used, but they are more or less painful 
and less easily controlled. The sinusoidal current is 
practically painless. The most convenient method 
of using the current is by means of the automatic 
exercise apparatus, which may be adjusted so as 
to cause any desired number of vigorous contrac- 
tions of the abdominal muscles per minute. 

By this means the abdominal muscles and the 
nerves and nerve centers which control them may 
be powerfully stimulated and their functions grad- 
ually restored. 

Electrical Stimulation of the Colon 

Applications of electricity to the surface of the 
body do not excite action in the colon; but the 
colon may be excited by the application of the 
current directly to the interior of the colon. This 
cannot be done by the patient himself, as the ser- 
vices of an expert proctologist are needed for the 
proper placing of the electrode. 

Electrical Stimulation of the Rectum 

The application of the sinusoidal current to the 
rectum by means of a proper electrode is a most 
effective means of stimulation of the rectum when 
its normal sensibility has been greatly diminished 
or greatly lost by neglecting to attend properly to 
Nature's "call" for evacuation of the bowels. For 
this purpose the very rapidly alternated current is. 



302 COLON HYGIENE 

best. The applications should be made daily. The 
duration of the application should be about ten or 
fifteen minutes, and the strength of the current as 
much as the patient can bear without discomfort. 
Not infrequently the effect of the application is to 
provoke an immediate evacuatipn of the bowels. 

Diathermy or Thermopenetration 

This new application of electricity which we 
owe to Dr. Nagelschmidt, of Berlin, is a most in- 
teresting medical use of the so-called wireless 
electrical current. In the body the high frequency 
waves of electrical energy are wholly converted 
into heat so that no electrical sensation or other 
sensation except heat is felt. The special advan- 
tage of diathermy over other forms of heat applica- 
tions is that the heat may be applied to the deepest 
parts as easily as to superficial parts. This is due 
to the wonderful penetrating power of this current. 

Diathermy is a valuable means for employment 
in the treatment of colitis. The application of 
the current to the spastic colon causes it to relax, 
and likewise relieves the pain in the colon as well 
as the back and other reflexly related parts. 



Special Treatment of Different 
Types of Constipation 

The practical management of cases of constipa- 
tion is in its main features the same irrespective 
of the type or form which the disease may assume. 
However, there are certain special features of each 
of the several characteristic phases of this diseased 
condition, which require special consideration. 

Without recapitulating the details of what has 
been said in the preceding chapters respecting the 
hygiene and preventive methods, the next few pages 
will be devoted to a summary of the methods which 
have proved most effective in dealing with several 
forms of constipation. 

Treatment of Simple Constipation 

The patient must set himself resolutely to im- 
prove his general health in every possible way. He 
must avoid all habits known to be injurious, such 
as the use of tobacco, alcohol, tea or coffee. Indulging 
in late hours ; irregular meals ; use of rich and highly 
seasoned foods; unwholesome dress; worry; and 
every unnecessary expenditure of vital energy which 
does not bring with it a compensating addition to 
vital resources, must be resolutely abandoned. The 
general rules and principles which have been set 
forth in the preceding chapters respecting the reg- 

303 



304 COLON HYGIENE 

ularity of bowel movement and the use of laxative 
foods in sufficient quantity must be scrupulously 
followed. 

The special exercises recommended for strength- 
ening the abdominal muscles, correcting wrong 
attitudes in sitting and standing, must be taken 
systematically twice a day. Feeble persons will, 
of course, begin with lighter exercises, increasing 
their vigor as they improve. No less than thirty 
minutes should be devoted to exercise daily. 

The exercise bath is especially recommended be- 
cause it economizes time by combining the tonic 
cold bath with vigorous exercise of the most help- 
ful sort. 

In all cases in which the colon is prolapsed, and 
when there is a flabby state of the abdominal mus- 
cles, a carefully fitted abdominal supporter must 
be worn. 

Diet 

The most important of all measures is the care- 
ful regulation of the diet, not only with a general 
view to a laxative effect, but to suit the needs of 
the individual patient. It must be remembered 
that, above all things, the food must be attractive 
and it should be eaten at such times and in such 
quantity that it will always be taken with keen 
relish. When the mouth waters at the sight and 
smell of food, it is a good sign that the whole di- 
gestive apparatus is ready to undertake the work of 
digestion with promptness and vigor. 



SPECIAL TREATMENT 305 

The bill of fare must as far as possible be made 
up of food stuffs which leave a residue of cellulose. 
Fine flour bread should be wholly discarded from 
the dietary. Bread or biscuit made from coarse 
graham meal or rye meal should replace other bread 
stuffs. It is in many cases advantageous to increase 
the amount of cellulose in the bread, by the addi- 
tion to graham flour of bran to the amount of about 
one-tenth the weight of the flour. The bran and 
graham flour should be prepared from well washed 
wheat. If such flour cannot be readily procured, 
wheat may be purchased, washed, dried and ground 
in a hand mill. A few bacteria introduced into a 
slice of bread prepared from unwashed wheat 
might not in itself be capable of doing any great 
amount of injury, but it must be remembered that 
under the favorable conditions presented by stag- 
nating fecal matters in the colon, poison-forming 
bacteria develop with extraordinary rapidity. 

All green vegetables should be freely used at 
the principal meals. Potatoes may be eaten in 
moderation, but should not constitute the chief 
vegetable food, for the reason that they are almost 
completely digested, containing a minimum amount 
of cellulose, as will be seen by reference to the 
table of vegetable foods. It is well to select those 
vegetables which are richest in cellulose. When the 
digestion is fairly good, such vegetables as beet- 
root, spinach, squash, asparagus, cabbage, carrots, 
turnips, and cauliflower should be very freely used. 



306 COLON HYGIENE 

Two or three of these vegetables may be taken at 
each meal. Uncooked vegetables of some sort 
should be taken at least twice a day at the principal 
meals. Lettuce, celery, cucumber and cabbage 
may always be taken with the greatest advantage, 
when the digestion is fairly good. There are very 
few who cannot take one or more of these green 
vegetables if care is taken to observe that they are 
fresh and crisp, and pains are taken to masticate 
thoroughly. Even radishes may be eaten in modera- 
tion, if the irritating skin is removed. 

Fruit, both stewed and fresh, should constitute 
a part of each meal. Fruit is especially valuable 
for the last meal of the day, and fresh fruit may be 
taken with advantage just before retiring at night, 
and as an early meal by those who rise early and 
breakfast late. The acids and sugars in fruits 
stimulate bowel action, but to secure this effect 
they must be taken in considerable quantity. Those 
who take two meals a day may often take with 
advantage two or three oranges or as many apples 
just before going to bed at night. Juicy fruit re- 
quires no work of the digestive organs, except to 
move it along and absorb the predigested nutrient 
which it contains. This remark, of course, does 
not apply to such fruits as dates, which contain a 
considerable amount of cane sugar, nor to the 
banana, which is really quite a hearty food, but 
relates only to such juicy fruits as oranges, apples, 
peaches, apricots, berries, pears and grapes. 



SPECIAL TREATMENT 307 

When the bill of fare consists largely of such 
food stuffs as fruits and vegetables, it is necessary 
to give careful attention to the actual food content 
of the meal. There is a wide variation in the 
amount of nutriment contained in different fruits 
and vegetables. For example, an ordinary serving 
of potatoes represents 100 calories of food, while 
a serving of cauliflower represents 25, and is mostly 
wood and water. A serving of beetroot represents 
25 calories, while a serving of cabbage or lettuce 
contains only 7 calories. 

Many persons suffering from constipation find 
it better to take two meals a day rather than a 
larger number. A full meal is a much stronger 
stimulus to the stomach and to the intestine than 
a mere "bite" of food or a half meal. By taking 
two good sized meals a day, a good bowel move- 
ment may usually be secured after each meal, while 
the same quantit}' of food taken at three or four 
meals might produce but one thorough movement, 
the stimulus of the smaller meals being only suffi- 
cient to produce a partial emptying of the intestine* 
The question as to the number of meals is one 
that should receive careful consideration, and often 
requires the exercise of the best skill and judg- 
ment. Stomachs which empty slowly require a 
longer interval between meals. 

It is especially important that care should be 
taken to include in the bill of fare a sufficient 
amount of fat. Fat is not only a nutrient of the 



303 COLON HYGIENE 

very highest value, but it is a laxative food ele- 
ment, partly because by its use the secretion of the 
bile and other intestinal juices is promoted, so that 
the intestine is benefited by their laxative influence, 
and also because a portion of the fat remains be- 
hind unabsorbed, acting as a lubricant and also 
as a stimulant to the colon. 

Most cases of simple constipation are promptly 
relieved by the adoption of the measures above 
recommended. The amount of bran may be in- 
creased almost ad libitum when necessary. In 
addition to the bran taken in the food, one or even 
two heaping tablespoonfuls of cooked and sterilized 
bran may be taken at each meal. Palatable prep- 
arations of bran are now available which makes 
possible the free use of this most important aid to 
bowel action without inconvenience. 

If any further assistance is needed it is to be 
found in the use of white Russian paraffin oil, the 
details concerning which having been given in a 
preceding chapter. (See pages 260-270.) 

Treatment of Cumulative Constipation 

In the treatment of cumulative constipation it 
is to be borne in mind that the principal obstacle 
to bowel movement is the undue accumulation of 
fecal matters either in the pelvic colon or the 
rectum, or as is most often the case, in both the 
pelvic colon and the rectum. In many cases the 



- 



SPECIAL TREATMENT 30? 

food is carried from the stomach to the colon with 
a proper degree of rapidity, and the feces move at 
the normal rate through the colon, until they have 
passed the splenic flexure. At this point the delay 
begins. In time, through extraordinary neglect, 
when the feces are allowed to accumulate for daj's 
and even weeks in succession, the colon and even the 
small intestine may become enlarged through the 
obstruction at the outlet. 

The chief cause of cumulative constipation, in 
ordinary cases, as has already been pointed out, is 
neglect to attend to the "call" of Nature for the 
evacuation of the bowels. When the "call" occurs, 
it is because the rectum is distended with feces. 

If the defecating mechanism then is interrputed 
in its action, and its purpose thwarted many times, 
the "call" becomes residuary, and the effort to 
defecate is so slight that it is easily suppressed. 
Later, in the worst cases, the desire to evacuate 
the bowels entirely disappears. In these cases the 
sensibility of the rectum has become blunted to 
such a degree that the normal reflex is lost. The 
rectum tolerates the presence of feces without pro- 
test and without giving any signal to the defecating 
center that bowel movement is required. 

It is evident, then, that in the treatment of cases 
of cumulative constipation the first and most essen- 
tial thing is restoration of the normal sensibility 
of the rectum. It must be remembered, however, 



310 COLON HYGIENE 

that in most cases of cumulative constipation, as well 
as in other forms of constipation, the condition has 
existed for a long time. The disease has conse- 
quently extended to the entire colon, and perhaps 
to the entire intestine, and success will not be ob- 
tained by attention to the colon and rectum alone; 
consequently, the treatment of cumulative constipa- 
tion requires the use of all the measures which have 
been recommended for simple constipation, the de- 
scription of which need not be repeated here. 

The first thing to be done, in beginning the treat- 
ment of cumulative constipation is to thoroughly 
evacuate the lower bowel and rectum. This is 
best accomplished by the use of the enema. It is 
certainly irrational to administer a laxative or 
cathartic, which disturbs the alimentary canal 
through its whole length, for the purpose of remov- 
ing an obstructive accumulation which perhaps lies 
within six inches of the lower outlet. 

A simple water enema at a temperature of 104° 
to 110° should be given to soften the hardened feces, 
and should be repeated at intervals of half an hour, 
until the colon is completely emptied, as shown by 
the return of clear water. The addition of soap 
to the water sometimes hastens the softening of very 
hard fecal matter. Warm oil has been much recom- 
mended, but it dissolves hard feces less rapidly than 
water. At first it may be impossible to introduce 
more than a small quantity of water, on account 
of the extreme distention of the rectum and pelvic 



SPECIAL TREATMENT 3 1 1 

colon with feces. By a persevering effort, however, 
success will be attained ; as the hard feces are gradu- 
ally softened and dissolved, larger quantities of 
water may be introduced until the whole colon may 
be filled with water and emptied of its putrefying 
contents. In cases in which the fecal accumulation 
has been going on for several weeks, the patient 
must be put in charge of an experienced nurse, 
whose efforts under careful instruction, must be 
unremitting until the task is completely accom- 
plished. When the feces are very hard, and the 
masses of considerable size, oil should be used at 
intervals to lubricate the walls of the bowels, which, 
in such cases, are often dry and sometimes rough- 
ened. 

After the bowels have been first thoroughly 
emptied, infinite care must be taken to see that an- 
other accumulation never occurs. Every time the 
bowel is distended by fecal accumulation, its muscles 
are weakened, the sensibility of its nerves dimin- 
ished, and any improvement which may have been 
secured by previous treatment is lost. By the sys- 
tematic use of the enema, the bowel being kept 
empty, gradually contracts and returns to something 
like its normal proportions. 

The cold enema should always be used for con- 
tracting the bowel after the fecal matters have been 
removed by a warm enema. When once the bowel 
has been thoroughly emptied, warm water may no 
longer be required, and it will not be necessary to 



312 COLON HYGIENE 

resort to the use of the hot enema. The tempera- 
ture of the water ordinarily used for the evacuation 
of the bowels may then be about 80°. After a little 
training, a lower temperature may readily be toler- 
ated and is greatly preferable. When very cold 
water is used, the effect is sometimes to produce a 
spasm of the anus, so that the contraction of the 
muscles prevents proper movement. When this 
occurs, the anus may be relaxed by the application 
of a sponge or napkin saturated with very hot water, 
or water of a higher temperature may be used for 
the enema. 

The best time for administering the enema is in 
the morning, after breakfast; but if circumstances 
will not permit this, the bowels may be moved at 
night after supper, or just before retiring. With 
patients who suffer from hemorrhoids or painful 
ulcers of the rectum, the hour of retiring is the best 
time for moving the bowels by an enema, as after- 
ward there may be prolonged rest on the back. This 
prevents the extrusion of swollen hemorrhoids or 
prolapsing rectum, and gives rest to the anal muscles, 
and so prevents the nagging, painful contractions 
which often follow bowel movement when fistulae 
or ulcers are present. 

By the systematic use of the cold enema the di- 
lated colon may gradually be restored to its normal 
size; its relaxed walls will recover their tone, and 
its function will be more properly performed. When 
sensibility of the rectum has been lost it may also 



SPECIAL TREATMENT 3 1 3 

gradually be recovered. It is necessary, however, 
that the greatest care should be taken to see that the 
colon and rectum are never once distended by fecal 
accumulation. Many persons suffering from cumu- 
lative constipation take an enema every other day, 
or once or twice a week, waiting for symptoms of 
accumulation before the enema is taken. This prac- 
tice is altogether wrong, and results only in a per- 
petuation of the disease. Of course, when an ac- 
cumulation occurs, it must be removed, but if a 
cure is expected, accumulations must not be per- 
mitted to occur. 

In obstinate cases the application of a sinusoidal 
electric surrent to the colon and the rectum aids 
greatly in the restoration of these parts to a normal 
condition. By the use of special electrodes electricity 
may be applied to the interior of the colon, as well 
as to the rectum, thus securing vigorous contractions 
of the bowel, which are not always produced by ex- 
ternal applications, especially in chronic cases in 
which the intestine has to a large degree lost its 
normal sensibility. While strong electrical appli- 
cations made to the spine and abdomen sometimes 
stimulate the muscles of the intestine as well as those 
of the abdominal wall, when the intestinal muscles 
have long been over-stretched and are perhaps to 
some degree degenerated, direct applications are 
necessary. These must be made by a physician by 
the aid of the proctoscope, which can be readily 
passed into the pelvic colon. 



314 COLON HYGIENE 

Vibration and massage of the interior of the 
rectum are measures of doubtful value. They are 
likely to give rise to abrasion and irritation of the 
mucous membrane, and are not to be recommended. 

In cases of cumulative constipation, in which 
painful ulcer or irritable hemorrhoids exist, effort 
to restore normal action of the bowels may be made 
ineffective by spasm of the sphincter muscles. This 
may be relieved temporarily by external applications 
of heat by means of a fomentation. A very effective 
plan is to move the bowels while sitting over hot 
water. Boiling hot water may be poured into 
a chamber or other suitable vessel. The steam re- 
laxes the anal sphincters, and not only facilitates the 
bowel movement, but relieves or prevents the pain. 

Dryness of the lower bowel due to deficient 
secretion, the result of chronic proctitis and asso- 
ciated with loss of rectal sensibility, is not infre- 
quently a cause of obstinate cumulative constipation. 
The stools are exceedingly hard and dry, and are 
discharged with great difficulty. When the rectum 
of such a patient is examined, the mucous membrane 
is found to be exceedingly dry, and often irritated. 
The normal lubricating mucus is not present. The 
result is the delay of the feces in the rectum until a 
dry hard mass is formed, which is not easily gotten 
rid of. In such cases, lubrication of the recrum 
is needed. The remedy for this is paraffin, of a 
special sort which melts at 102° F. For details 
respecting the use of this highly valuable remedy 
see pages 260-270. 



SPECIAL TREATMENT 3 1 5 

Treatment of Latent Constipation 

In this form of constipation the stools are regular, 
the bowels move every day, and there is no accumu- 
lation of feces in the rectum. The patient is gen- 
erally unaware of the fact that he is suffering from 
constipation, although not infrequently an observing 
patient becomes satisfied that there is something 
wrong, often because of too frequent bowel move- 
ments, which are not uncommon, together with pain, 
the passage of mucus, perhaps, and other symptoms. 

In a London clinic the writer once heard a 
Scotch laborer complain of very frequent bowel 
movement. The examining doctor said to him, 
"Then you are suffering from diarrhoea". "No, 
Doctor," replied the patient, "I think I am suffer- 
ing from constipation in diarrhoea form," — a good 
practical description of certain forms of latent con- 
stipation. This patient was found to have a very 
extensive accumulation of feces due to cancer of the 
rectum. 

In addition to the most thoroughgoing application 
of all the measures recommended for simple con- 
stipation, a thorough examination including an 
X-ray inspection of the w T hole intestinal tract, after 
a bismuth meal must be made. The rectum and 
lower bowel must be carefully examined to exclude 
cancer or other organic disease. Careful examina- 
tion must be made in the region of the appendix, 
and in women a thorough pelvic examination is 



316 COLON HYGIENE 

necessary, since in many cases the delay may occur 
above the ileocecal valve, in consequence of spasm of 
the sphincter at this point. Or the delay may be 
due to incompetency of the ileocecal valve. 

"Lane's kink" may be an occasional cause of 
latent constipation. It is more likely to be a result 
of this condition. 

When the difficulty is due to spasm of the ileo- 
cecal valve, the result of reflex irritation from the 
inflamed appendix or from inflammation of the 
ovaries, uterus, bladder, or prostate, or painful 
disease of the rectum, it is of course necessary that 
these conditions should be removed by proper treat 
ment. Temporary relief is generally most readily 
obtained by hot fomentations over the abdomen, 
with special attention to the seat of pain. The hot 
sitz bath, the hot enema and the wet girdle covered 
with mackintosh, worn day and night, are measures 
of great importance, and often secure very complete 
and speedy relief. 

When the intestinal inactivity is the result of 
general feebleness, short cold baths should be em- 
ployed daily. A cold bath may consist of a general 
cold shower of from fifteen to twenty seconds' dura 
tion, a cold douche to the spine, a cold towel rub. 
or cold sheet rub, according to the strength of the 
patient. The cold bath should be preceded by a 
short electric light bath. It aids in the elimination 
of accumulated toxins, and prepares the skin to react- 
to cold application. 



SPECIAL TREATMENT 3 1 7 

In latent constipation, the enema is sometime? 
useful chiefly as a means of introducing water by 
which the accumulated toxins may be washed out 
through the kidneys. In such cases the difficulty 
lies too high to be reached by the enema. The large 
cool or cold enema may, however, render service in 
cases in which the delay is due to atony, by improv- 
ing the tone of the bowel muscles and so aiding peris- 
taltic movement, by which the accumulated putrefy- 
ing material in the lower part of the intestine may 
be moved on to the colon, and so be gotten rid of, 
The cold enema should not be used, however, in 
cases where there is reason to suspect spasm of the 
ileocecal valve, which is likely to be the case when 
latent constipation is associated with painful disease 
in any part of the pelvic region. In these cases a hot 
enema should be employed. 

The rapid absorption of water from the colon 
is shown by the copious discharge of urine which 
usually appears within a few minutes after an enema 
is taken. The increase in the quantity of urine 
occurs so quickly after a large enema, that some 
medical writers in the early part of the last century 
were led to advance the theory that a direct con- 
nection existed between the colon and the kidne5^s 
This fanciful theory has, of course, no anatomical 
foundation. 

Mechanical kneading, the application of the sinu- 
soidal current, and intelligently administered mas- 
sage and other means by which success may be 
attained in combatting latent constipation. 



318 COLON HYGIENE 

The Treatment of Spastic and Reflex 
Constipation 

These conditions, most commonly associated with 
colitis or appendicitis, require the use of special 
measures. In spastic constipation the cause of stag- 
nation of the intestinal contents may rest anywhere 
between the ileocecal valve and the anus. 

In many cases of so-called spastic constipation, 
this condition is only a complication of colitis or 
chronic infection of the colon, due to delay of fecal 
matters in the colon. 

The best means of securing immediate relief in 
cases of this sort are the hot sitz bath, the hot 
enema, and hot fomentations or diathermy applied 
over the abdomen. 

In cases of painful disease of the ovaries or uterus, 
the hot vaginal irrigation must be used in addition 
to the hot enema. 

The constipation which occurs at the monthly 
period in women suffering from menorrhagia, may 
often be removed by a hot hip and leg pack applied 
by means of a woolen blanket wrung out of water 
as hot as possible. The application of cold water 
after the pack should be avoided. The patient 
should be wrapped in dry blankets, and gradually 
cooled by tepid spraying. 

Sometimes the warm oil enema proves more ser- 
viceable than the hot water enema, because less 
irritating. The addition of salt to the water is 



SPECIAL TREATMENT 319 

sometimes useful in cases in which the mucous mem- 
brane of the intestine is eroded, as a weak solution 
of salt is less irritating to raw surfaces than pure 
water. 

The application of the arc light and the photo- 
phore are extremely useful means of relieving the 
internal spasm. These applications should be made 
daily for ten to fifteen minutes' duration. In 
severe cases the light applications may be intensified 
by a special device through which the excessive rise 
of temperature is prevented by a stream of cool air 
or water playing upon the abdomen. 

When making general cold applications, the abdo- 
men should be protected by a warm flannel or a hot 
fomentation. A patient suffering from constipation 
must take special care to avoid chilling, and must 
keep the feet and hands warm. The chilling of the 
hands and feet always aggravates the spasm. The 
drinking of ice-cold water must also be prohib- 
ited. 

The cold towel rub is especially suited to these 
cases, as a general tonic measure. 

A person skilled in massage may make good use 
of this measure in the general application of heat, in 
cases in which massage is indicated, as when the 
cecum is loaded as the result of contraction of the 
transverse colon, or at the splenic flexure. The ten- 
dency of massage to aggravate the contraction is 
counteracted by a general application of heat. 

The moist abdominal bandage without the mack- 



320 COLON HYGIENE 

intosh cover should be done at night and if possible 
also during the day time. 

The abdominal supporter is also highly important 
in these cases, to prevent drag upon the mesentary 
by prolapse of the bowels. The writer has ob- 
served several cases in which the, wearing of an 
efficient abdominal supporter has given prompt re- 
lief from very obstinate constipation. 

The Treatment of Mixed Cases of 
Constipation 

In many, perhaps the majority of cases of con- 
stipation, the type of the disease is mixed. The 
association of spastic constipation with latent or 
cumulative contipation is specially common. Cases 
which begin as simple constipation, later become 
cumulative constipation, and finally develop spastic 
or latent constipation through infection of the colon, 
or colitis, the natural result of stagnation of the 
bowel contents. 

The measures recommended for the treatment 
of spastic constipation should be applied with such 
other measures as may be indicated. If the rectum 
and the pelvic colon are filled with feces, these 
must be removed by the means recommended in the 
treatment of cumulative constipation, and the gen- 
eral measures suggested for the relief of that form 
of the disease must be perseveringly employed. 

In the use of electricity in cases of this sort, the 



SPECIAL TREATMENT 321 

applications must be combined with hot applications, 
in order to avoid increase of the spastic contraction. 

When electricity is applied to the rectum, a 
fomentation should be applied to the abdomen dur- 
ing the application, or immediately afterward. 

The thermophore affords the most effective means 
of applying heat to the abdomen during electrical 
applications. During a general cold application 
heat should be applied over the abdomen, to pro- 
tect the intestine. 

A flannel bandage should be worn over the 
abdomen constantly when the moist abdominal 
bandage is not employed, ar/d an abdominal sup- 
porter should be worn. 

Coarse vegetables and other bulky food stuffs 
should not be avoided because colitis is present 
Colitis is the result of constipation, and this will be 
aggravated by the bland concentrated diet, which 
is commonly recommended for colitis. Experience 
has very clearly demonstrated the value of a bulky 
vegetable diet in colitis as well as in constipation. 

Agar-agar is specially valuable in these cases, for 
the reason that it affords bulk, and aids in clearing 
away the accumulated mucus, while at the same 
time producing no irritation. The irritation sup- 
posed to rise from the cellulose of fruits is far less 
than is generally thought. Bran and ground wood 
have been used with excellent results as poultices 
for raw surfaces and dressings for wounds. Wet 
bran, like wet paper, is not irritating. 



Treatment of Disorders Which 
Result from Constipation 

While constipation, through the autointoxication 
to which it leads, is both an exciting and predis- 
posing cause of many very serious chronic diseases 
from which human beings suffer, there are many 
other maladies which are so immediately aggravated 
by an inactive state of the bowels, that this condi- 
tion becomes a dominant factor in dealing with 
them. In this chapter a brief mention will be made 
of the more important of these diseases. 

Catarrhal Colitis 

The chief seat of this disease is the lower colon, 
especially the pelvic colon and the iliac colon. 
Sometimes, however, the effect extends to the 
entire colon. 

The disease is essentially a chronic infection of 
the mucous membrane, and is the result of the 
injury done to the tissues by the prolonged contact 
with putrefying fecal matters which in constipation 
accumulate and are often retained for days in the 
lower colon. To understand the effect of these 
poisonous matters upon the mucous membrane, 
when acting continuously for days with constantly 
increasing virulence, it is only necessary to consider 
for a moment what result would follow an applica- 

322 



TREATMENT OF DISORDERS 323 

lion of the same sort of material to the skin 
for several days in succession. The remarkable 
vitality with which the mucous membrane is en- 
dowed, enables it to retain its integrity for a con- 
siderable length of time, but sooner or later, its 
resistance breaks down, and it becomes the seat of 
a chronic inflammation similar to that which affects 
the mucous membrane of the nose in nasal catarrh. 
An examination of the stools shows constantly 
present mucous and white blood ceils, which are 
thrown off by the mucous membrane in its efforts 
to defend itself against the attack of the myriads 
of microbes which are constantly assailing it, and 
the various highly virulent poisons which they 
produce. The character of these poisons may be 
judged from the nauseous odors emanating from 
the putrefying feces which are discharged when 
a laxative is administered, and sometimes as the 
result of an enema. The real character of the feces 
produced by a constipated person cannot alwa) r s be 
judged by an examination of the hard, dry masses 
which are discharged from the lower bowel, for the 
reason that the noxious substances which they con- 
tained have been absorbed higher up in the bowel. 
Some persons, indeed, have made the mistake of 
supposing that the comparatively inodorous feces 
which they discharged, and which have been, 
retained so long that they have become as hard and 
dry as wood, afford evidence of an exceptionally 
aseptic and wholesome state of their intestine. In 



324 COLON HYGIENE 

one such case the writer succeeded in disabusing 
the mind of a very optimistic individual, by ad- 
ministering a dose of charcoal, which, acting as a 
laxative, brought down from the cecum and trans- 
verse colon a semi-fluid stool which was loathsome 
almost beyond description, and which when sub- 
mitted to chemical and bacteriological examination, 
was shown to contain prodigious numbers of 
bacteria, and putrefaction products in extraordinary 
amount. This person, a man of unusual intel- 
ligence, but unacquainted with the physiology and 
bacteriology of the intestine, lived under the er- 
roneous impression that by the thorough mastication 
of his food he rendered digestion so complete, and 
his intestine so sterile, that the putrefactive processes 
commonly present were suppressed, whereas, the 
truth was that putrefaction was very active in his 
colon, and his feces were inodorous only because 
they had been retained so long that the putrefactive 
process had consumed everything putresicible, and 
the maladorous and other substances had been taken 
up into the blood by the absorption, and had been 
discharged through the lungs, skin and kidneys, 
instead of being eliminated through the bowels, the 
natural and only safe and decent outlet for such 
loathsome products. In this case, as might be ex- 
pected, evidence of the presence of catarrhal colitis 
was present, the little knob of wooden-like feces 
discharged at intervals of several days, being always 
covered with a thick layer of opaque mucus. 



TREATMENT OF DISORDERS 325 

The frequent bowel movement in colitis is due 
not only to the irritation produced by the stagnation 
of fecal contents but to the fact that the contracted 
bowel relaxes at intervals and permits the passage 
of material which has been accumulated above it. 
When the bowel is completely contracted the ob- 
struction is complete. In examining the patients 
suffering from colitis the writer has often noticed 
the complete relaxation of the bowel which but a 
few moments before was so contracted that it could 
be rolled under the finger like a piece of thick 
rubber tubing. 

In catarrhal colitis, the stools may be either 
liquid, or composed • of hard lumps somewhat re- 
sembling the feces of goats, or they may be mixed 
in character. The stools are sometimes quite watery 
in character, and may contain traces of blood. 
Patients often think that they are suffering from 
diarrhoea, on account of the frequent semi-liquid 
discharges. The cause of liquid stools is the irrita- 
tion produced by the hardened and irritating feces. 
The irritation is not mechanical, however, but is 
due to the poisonous and irritating substances which 
are produced by the bacteria growing in the feces, 
in other words, by the putrefaction which is taking 
place. 

In many cases there is a quite regular alternation 
of constipation and diarrhoea; the feces accumulate 
for several days, when the irritation becomes so 
great that by a profuse flow of serum and an 



326 COLON HYGIEiNE 

abundant secretion of mucus occurs, the mass is 
softened, and temporary relief is obtained through 
the complete or partial unloading of the bowels by 
several soft stools. 

This condition, which is usually associated with 
cumulative constipation, is often complicated by a 
latent constipation, which results from spastic con- 
traction of the bowel. The most common seat of 
this contraction is the descending or pelvic colon; 
but it may often be noted in the transverse and 
ascending colon. In these cases, the autointoxication 
which is always present is more pronounced in 
degree, because of the more fluid character of the 
intestinal contents in the upper bowel. That the 
disease not infrequently extends to the whole colon 
is shown not only by the contracted condition of 
the ascending colon and even of the cecum, but 
also by the presence of masses of hardened feces 
which may be frequently felt in both these portions 
of the colon. 

The ultimate effect of long-continued inflamma- 
tion of the mucous membrane is the same in the 
colon as in the nose and other parts provided with 
a mucous lining. After a time, which varies accord- 
ing to the resistance of the individual and the in- 
tensity of the disease, degenerative changes occur 
in the mucous membrane; its glands disappear, and 
it becomes thin and parchment-like. The degenera- 
tion extends to the muscles which lie beneath the 
mucous membrane. The intestinal wall is thus 



TREATMENT OF DISORDERS 327 

thinned and weakened and loses its power of con- 
tractility to a large degree; it becomes distended 
and enlarged by gases and fecal accumulation, and 
thus the difficulty becomes greatly aggravated. In 
these cases, the colon, or at least the portion of it 
which is affected, becomes much like a distended 
bladder, losing a large part of its functions as a 
living muscular tube; it fails to respond to the 
nervous impulses by which the act of defecation 
is normally affected, and serves merely as a reservoir 
in which accumulate waste and remnants of un- 
digested and undigestible foodstuffs, there to remain 
undergoing fermentation and putrefaction, develop- 
ing offensive gases and irritating poisons, until re- 
moved from the body by some mechanical means. 
In these cases an essential part, of the defecating 
mechanism is practically destroyed or rendered in- 
operative, and it becomes necessary to resort to me- 
chanical means, as an enema of water or oil, for 
emptying the bowels. Lane and other surgeons 
have removed the colon in these cases, an operation 
which is doubtless sometimes necessary, although 
less often required than has been advocated by some, 
provided the patient can have the benefit of a com- 
plete regulation of the dietary, and will follow a 
suitable regimen. 

The disastrous consequences which result from 
chronic catarrhal colitis are not confined to the colon. 
The disease often extends to the small intestine. In 
aggravated cases the accumulation in the cecum 



328 COLON HYGIENE 

becomes so great that the ileocecal valve is dilated 
to such an extent that the contents of the cecum 
and small intestine intermingle. The very perfect 
valve arrangement provided by Nature at the 
junction of the small intestine with the colon, which 
is rendered still more effective by a sphincter 
muscle placed just above it, is evidently intended 
to prevent any possible return of matters from the 
colon to the small intestine. In the small intestine 
the presence of carbohydrates prevents the growth 
of putrefactive organisms, by encouraging the forma- 
tion of acids. In the colon, however, especially 
when there is stasis or accumulation of fecal matters, 
the delay permits the complete absorption of starch 
and sugar, so that there is no material to encourage 
the acid-forming bacteria, and the poison-forming 
microbes, being unhindered, undergo rapid develop- 
ment, and greatly increase in virulence, finding 
always plenty of food material in the mucus, bile, and 
other intestinal secretions, as well as the larger or 
smaller quantities of food protein which remains 
undigested or unabsorbed. When these dangerous 
microbes are carried into the small intestine, they 
may continue to develop and gradually work their 
way up the intestine. 

The cecum becomes dilated and distorted in 
shape, because of the weakening of its walls in 
consequence of the undue accumulation of its con- 
tents. The cecum may be so dilated and stretched 
that it is found far over toward the left side of 



TREATMENT OF DISORDERS 329 

the body, or lying deep down in the pelvis. The 
damaged ileocecal valve no longer controls the 
opening between the small intestine and the colon. 
The feces are no longer found exclusively in the 
colon. The small intestine may for several feet be 
filled with fecal matters of the consistency of putty, 
such as are normally found only in the transverse 
colon and beyond. 

Putrefaction of the contents of the small intestine 
is a very much more serious matter than putrefaction 
in the colon, for the reason that the small intestine 
is much more richly supplied with absorbents, and 
is also less prepared to defend itself against the at- 
tacks of the virulent miscrobes' which are always 
present in connection with putrefactive processes. 

This infection of the small intestine with fecal 
matters introduces a whole series of troubles which 
unfold as the infection ascends along the intestine. 
The ascending infection finally reaches the duo- 
denum, which not infrequently becomes the seat of 
a chronic catarrhal condition, the result of which 
may be ulceration. Observations of Moynihan and 
others have shown that duodenal ulcer is three or 
four times as frequent as ulcer of the stomach. 
Pain occurring three or four hours after meals is 
very frequently due to duodenal ulcer. From the 
duodenum, infection often travels through the bile 
ducts to the liver and the gall bladder. Chronic in- 
fection of the gall bladder and gall stones are thus 
developed. The infection may also ascend the pan- 



330 COLON HYGIENE 

creatic duct, which is closely associated with the 
bile duct, and may cause chronic inflammation of 
the pancreas, one of the results of which may be 
diabetes. From observations recently made respect- 
ing the causes of diabetes it is probable that inflam- 
mation of the pancreas arising in this way is among 
the most common causes of this disease. Observa- 
tions made in the X-ray department of the Battle 
Creek Sanitarium indicate that the ileocecal valve 
is usually incompetent in diabetes. This is a most 
significant fact. The ileocecal valve protects the 
small intestine from infection; when it becomes in- 
competent, there is nothing to prevent the develop- 
ment of an ascending infectious process, which may 
bring about all of the conditions above mentioned. 

Treatment 

The successful treatment of colitis requires, first 
of all, a change of the intestinal flora; that is, the 
infectious bacteria to which the disease is due must 
be gotten rid of. Since the first cause of colitis 
is constipation, it is evident that frequent bowel 
movement is also essential ; in other words, the colon 
must be kept clean. The diarrhea which is some- 
times present in colitis is the result of Nature's ef- 
fort to clear the intestine from offending materials. 
The mucus which is often discharged in large quan- 
tities is a protective material which Nature pours 
out upon the surface of the intestine to protect the 
tissues against the attacks of bacteria and parasites 



TREATMENT OF DISORDERS 331 

which flourish in the colons of persons suffering 
from this disease. 

Various species of bacteria are capable of giving 
rise to colitis, according to Tissier. In general, it 
may be said that colitis is the result of the presence 
in the colon of excessive numbers of putrefactive 
bacteria. 

In recent years, attention has been called to 
the fact that acute infections of the colon are 
sometimes due to animal parasites. Certain amoebae, 
flagellates, spirochetes and other forms of protozoa 
are also found in great numbers in the colon in cases 
of chronic constipation and colitis, as well as in cases 
of amoebic dysentery. These organisms have been 
regarded by most authorities as pseudo parasites, 
with the exception of those of amoebic dysentery. 
Dr. Ronald Ross has recently pointed out the fact 
that all these organisms are parasitic and dangerous. 
If they do not set up acute inflammation character- 
istic of amoebic dysentery, they bore into the mucous 
membrane and thus prepare hiding places for per- 
nicious bacteria, which develop chronic infections 
and intestinal toxemia. Observations made a few 
years ago by Miss York show that these animal 
parasites are rarely found in the stools of persons 
who subsist upon a non-flesh dietary. They abound 
in feces which are in part made up of undigested 
residues of flesh foods. 



332 COLON HYGIENE 

Measures Essential in the Treatment 
of Colitis 

As already stated, it is necessary in the treat- 
ment of colitis first of all to adopt thoroughgoing 
measures to secure a change of the intestinal flora. 
The writer has found that this may be accomplished 
in a short time by placing the patient on a special 
diet, which for convenience is termed a fruit regi- 
men. For a description of this regimen see page 
191. After a few days of this regimen (three days 
to a week) the character of the stools will be found 
to be wholly changed. The stools become soft, al- 
most odorless and frequent, the tongue clears, the 
appetite is keen and is satisfied with simple foods. 
Cereals and a moderate amount of fats can now be 
added to the bill of fare, but the fruits, bran or 
agar-agar, and paraffin must be continued. 

The diet must be made so bulky and laxative that 
the bowels move three or four times a day. Four 
movements a day are better than three. The stools 
should be odorless or they may have a slight sour 
odor. An ammoniacal or putrid odor is evidence 
that the flora has not yet been changed, and the 
fruit regimen must be continued or repeated after 
a few days. Sometimes several repetitions of the 
regimen at intervals of a week or two are required 
for complete success. Animal products of all sorts 
must be avoided. Even milk must be excluded, as 
well as eggs and meat. As pointed out by Tissier 



TREATMENT OF DISORDERS 333 

some years ago, the bacteria which produce colitis 
thrive best upon animal protein. 

Another point of importance is to supply the 
colon with carbohydrates. Sugar administered by 
the mouth never reaches the colon, for the reason 
that it is so readily absorbed that it is all taken up 
by the small intestine. Cooked starch is digested so 
quickly that it is also absorbed from the small in- 
testine, only a mere trace reaching the colon. The 
way to get carbohydrate into the colon is either to 
introduce it by enema, or to administer it in an un- 
cooked, or partially cooked, state, so that it may 
have an opportunity to reach the colon before diges- 
tion is complete. It is well known that saliva does 
not act upon cooked starch. 

Raw starch may be digested by the pancreatic 
juice, but the process is very slow, and so k when 
starch is taken raw a considerable proportion, ten 
to twenty per cer.t according to the writer's observa- 
tions, may reach the colon. In the colon there are 
always present bacteria capable of digesting raw 
starch and converting it into sugar. When sugar 
is present, not only the ordinary lactic acid forming 
bacillus but the various putrefactive bacteria seize 
upon the sugar with great avidity and convert it 
into lactic acid. It appears that even putrefactive 
germs are putrefactive, or carnivorous, only when 
compelled to be so through the absence of carbo- 
hydrate in available form. When sugar is present, 
putrefaction does not take place. This important 
fact was pointed out by Kendall some years ago, 



334 COLON HYGIENE 

and demonstrates that it is possible to reform the 
bacteria of the colon, and this is much more easily- 
accomplished than to drive out the various species 
of bacteria which, in most cases, have been thor- 
oughly established in the intestine for years, and 
occupy every nook and corner of the colon; they 
cling so tenaciously to the territory which they have 
invaded, that it is practically impossible to drive 
them out so completely that a sufficient number 
will not be left behind to quickly re-establish them- 
selves when favorable conditions develop. 

Raw starch may be introduced in various ways. 
A convenient method is by the use of "brose" (see 
page 237). Another excellent plan is the follow- 
ing: Pour into a bowl six ounces of boiling water. 
Rapidly stir in a heaping tablespoonful of fine oat- 
meal, or rolled oats, which has been passed through 
a vegetable grinder. Let it stand one side for five 
minutes and add a little salt and eat as porridge. 
The preparation is not unpalatable. If desired, it 
may be taken as a beverage with the addition of a 
little water or fruit juice. 

In addition to the above, there are several other 
highly effective measures which may be advantage- 
ously employed in the treatment of colitis. Not- 
withstanding the free use of bran or agar-agar and 
paraffin, the colon may be so crippled that it does 
not completely empty itself and a sufficient amount 
of material is constantly left behind to encourage 
putrefaction, and to prevent the healing of the dis- 
eased surfaces. Examination with the X-ray shows 



TREATMENT OF DISORDERS 335 

in these cases a spastic, or contracted, condition of 
the descending or pelvic colon, and in many cases 
a prolapsed condition of the pelvic colon, which 
may be adherent. In these cases, the colon must be 
daily washed out by means of an enema consisting 
of two or three pints of salt water. The tempera- 
ture of the water should be 105° to 108°. The 
enema should be repeated several times, or until the 
water returns clear. The effectiveness of the enema 
is greatly increased by thorough massage of the 
colon, especially of the pelvic colon, with the patient 
in the knee-chest position. When the pelvic colon 
is distended by the enema it may be manipulated 
more effectively. 

After the colon has been thoroughly emptied, an 
injection is made consisting of a culture of Bacillus 
Bulgaricus in whey, to which has been added a 
small portion of well boiled starch and also a small 
quantity of malt sugar. By this means the colon 
is inoculated with germs; in other words, a new 
flora is planted and supplied with the material to 
promote its growth and development, and to help 
reform the wild bacteria of the colon to which co- 
litis is due. 

It is well to use short tonic baths, the moist ab- 
dominal bandage, fomentations and other applica- 
tions of heat to this region. Light baths, and meas- 
uses of all sorts which build up the general health, 
must supplement the local measures above suggested. 
This method of dealing with cases of colitis has 
long ago passed the experimental stage. By thor- 



336 COLON HYGIENE 

ough application of these simple means many hun- 
dreds of chronic sufferers from colitis have been not 
only relieved, but cured. It must be remembered, 
however, that the measures found necessary to effect 
a cure of this distressing ailment must be adhered 
to more or less strictly after the cure, as the only 
certain means of preventing recurrence. 

Proctitis 

In cases in which cumulative constipation in- 
volves the rectum, infection, here known as 
proctitis, develops in this part also. Infection may 
extend from the pelvic colon into the rectum. When 
the rectum is involved, the patient often suffers 
from more or less constant pain and uneasiness in 
this region; there may be frequent desire to move 
the bowels, but however frequently the bowels may 
be moved, there will always be some feces remain- 
ing in the rectum, together with mucus and, oc- 
casionally, blood. An examination of the rectum 
sometimes shows ulceration. In advanced cases, 
the mucous membrane is smooth and dry, with 
patches of mucus adhering here and there, and 
frequently raw surfaces which bleed when touched. 
The conditions are identical with those which are 
found in the bowel higher up. The point of junc- 
tion of the colon and the rectum is a favorite 
jeat for ulcerations and thickenings of the mucous 
tiembrane. 



TREATMENT OF DISORDERS 337 

When the disease extends deeper into the wall of 
the bowel, as it does sooner or later, thickening and 
rigidity result. By extension of the disease through 
the membranous wall, the outer surface becomes 
inflamed, and adhesions may occur between the 
lower bowel and the bladder, which sometimes 
result in fistulae between the two viscera. Adhesions 
may also occur between the colon and small in- 
testines and other parts; the ulcerations may heal 
and form cicatrices, which contract and produce 
obstruction. The lower part of the rectum and the 
juncture of the colon and rectum, the pelvirectal 
valve, usually show the worst effects of catarrhal 
colitis, and these points are the favorite seat of 
cancerous growths. The long continued irritation 
to which these parts are subjected also leads to the 
development of other growths, which, together with 
ulcerations, as has been shown by Mummery, a 
very eminent London specialist, are very prone to 
develop into cancer, and on this account, every 
person who suffers from catarrhal colitis, as shown 
by the presence of mucus in the stools, should 
submit himself to a physician for examination in 
order that any existing tendency towards maligancy 
may be recognized sufficiently early to permit of 
its radical treatment. 

The treatment of proctitis is essentially the same 
as that already outlined for colitis. Change of the 
intestinal flora, frequent bowel movements, daily 
cleansing of the colon, an anti-toxic diet, and the 



338 COLON HYGIENE 

introduction into the colon of cultures of lactic acid 
forming organisms are the most important measures. 
Faithful employment of these measures will usually 
effect a cure. 

Muco-membranous Colitis 

This disease is probably only a variety of the 
preceding. Of this the writer has been convinced 
for many years, although most authorities still 
describe this malady as a nervous disorder. The 
only particulars in which it differs from catarrhal 
colitis are: 

1. The fact that mucus is not constantly present 
in the stools as in catarrhal colitis. 

2. The presence of membranes which are some- 
times complete casts of the bowel, and may be a 
foot or more in length. 

3. Colic pains. 

4. Intermittent occurrence of the symptoms. 
These differences are not sufficient to characterize 

this condition as a distinct disease. Constipation 
is the predisposing condition which lies back of this 
disease, as well as of catarrhal colitis. If the in- 
fection is not sufficiently intense to produce con- 
tinuous symptoms, it is only necessary that it should 
be increased by some indiscretion in diet, exhaustion, 
a severe cold, or some other factor, to precipitate 
an attack. The casts consist of coagulated mucus, 
and not mucous membrane as patients often imagine. 



TREATMENT OF DISORDERS 339 

The colic pains are due to violent contraction of 
the colon, which are excited by the accumulation 
of gas and irritating fecal matter. This disease 
is often associated with chronic affections of the 
pelvic organs, and is much more frequent in women 
than in men. 

Colitis in any form is a serious condition which 
cannot be safely neglected. Sooner or later it creates 
conditions which are beyond remedy except by 
surgical means. 

Treatment 

The treatment of this condition does not differ 
from that already outlined for the treatment of 
colitis. Medicinal laxatives of all sorts must be 
avoided, because these only serve to aggravate and 
perpetuate the disease. 

Enlargement of the Liver and Spleen 

Marked enlargement of the liver and spleen are 
frequently the result of chronic constipation with 
intestinal autointoxication. The constant flooding 
of the liver with toxins must result in damage to 
its tissues. Boix showed this in his experiments 
upon rabbits. Some years ago the writer en- 
countered a case of enormous enlargement of the 
liver, in which there had never been any use of 
alcohol, and there could be found no more tangible 
cause for the disease than a chronic constipation 



340 COLON HYGIENE 

which had existed for many years. The writer has 
seen many cases of decided enlargement of the liver 
and spleen, in which constipation and autointoxica- 
tion existed to a marked degree. 

Fecal Tumors 

When the obstruction which causes a delay in 
the movement of feces through the colon is 
permanent, the mass of accumulated feces may at- 
tain such a size as to be easily felt through the 
abdominal wall. Fecal tumors may generally be 
distinguished from other tumors by their doughy 
consistency, that is, their shape may be moulded 
by pressure with the fingers. Such forms sometimes 
disappear suddenly and may be broken up by the 
manipulation of the hands, or softened by means 
of enemas of warm water or warm oil. Sometimes 
a surgical operation is necessary for their removaL 

The late Dr. Lawson Tait told the writer of 
a case to which he was called to operate for the 
removal of a large abdominal tumor, which proved 
to be a tumor of this sort. On opening the abdo- 
men, the small intestine was found to be enormously 
distended just at the ileocecal valve. On inquiry, 
it was found that the patient, who was recently con- 
valescent from typhoid fever, had swallowed rather 
rapidly a large quantity of milk. Suspicion at once 
arose in the mind of the surgeon that the mass might 
consist of undigested curds. With this idea in mind, 
he carefully manipulated the tumor with his fingers. 



TREATMENT OF DISORDERS 341 

and finally succeeded in breaking up the mass to 
such a degree that it became possible to push the frag- 
ments through the ileocecal valve, and thus a more 
serious operation was avoided. 

Volvulus 

Sometimes the processes which begin in the in- 
testine and work outward through the intestinal 
wall give rise to inflammatory changes in the mem- 
branous fold of mesentery to which the pelvic loop 
of the colon is attached. As a result the mesentery 
is gradually shortened until the ends of the loop 
are brought close together and fixed. With the 
colon in this position, there is a great risk of ob- 
struction from the twisting of the loop, which 
occasionally happens, giving rise to what is known 
as volvulus. In a case of this kind prompt surgical 
relief is very essential. A short delay may give 
rise to gangrene of the intestine, and general 
peritonitis. 

Disorders of the Stomach 

Although l'ocated at the other extremity of the 
digestive canal from the colon, the stomach is, 
nevertheless, in various ways and to a profound 
degree influenced by chronic constipation. Loss of 
appetite is a very common symptom in constipation, 
and so constipation is increased through the lack 
of the vigorous stimulation given to the movement 
of the intestine by the taking of food with relish. 



342 COLON HYGIENE 

Hyperhydrochloria, gastritis, and even ulceration 
in the stomach and duodenum are by many eminent 
medical men attributed to the stagnation of the 
intestinal contents. 

Diseases of the Heart and Blood Vessels 

Palpitation of the heart is a common consequence 
of an acute accumulation of feces in the. colon, 
probably the result of the excessive absorption of 
toxins to which such accumulations give rise. 

Pseudo-angina pectoris, in which the patient suf- 
fers pain in the region of the heart entirely sim- 
ilar to those which occur in angina pectoris, are 
frequently associated with chronic constipation. 
Chronic constipation or the autointoxication result- 
ing from it may be regarded as a cause of true angina 
pectoris as well as of pseudo-angina. Arteriosclero- 
sis affecting the vessels of the heart has been clearly 
shown by Bouchard and other authorities to be 
one of the common results of chronic constipation, 
and attacks of angina pectoris often appear among 
other symptoms of the degenerative changes which 
have taken place. Years ago Boix of Paris showed 
that the poisons produced by the colon bacillus are 
capable of producing these degenerative changes 
which result in sclerosis of the arteries of the liver, 
spleen, and other glands. 

Premature Senility 

The senile appearance of many persons who have 
long suffered from chronic constipation, as well as 



TREATMENT OF DISORDERS 343 

the steady decline of longevity in countries in which 
constipation is prevalent, is evidence of the mis- 
chievous results of the constant absorption of the 
poisons produced by colon germs which Metch- 
nikoff regards as the cause of old age. The pig- 
mentation of the skin appearing first about the eyes 
and as brown spots upon the hands, the thinning of 
the skin of the hands and parchment-like appearance 
of the skin are familiar symptoms of senility induced 
by alimentary toxemia. It is highly important to 
note that these senile changes are not confined to 
the skin. The changes in the skin are only the 
external signs of similar degenerative changes tak- 
ing place in the bloodvessels, liver, kidneys, and 
other vital internal parts. 

Disease of the Kidneys 

The poisoning resulting in chronic constipation 
is frequently indicated by the appearance of albumen 
and casts in the urine. A long continuance of this 
poisoning gives rise to changes in the kidney, which 
are commonly known as Bright's disease. It is in- 
deed quite possible that chronic constipation may be 
one of the most important of all causes of this 
terrible malady. Statistics of all civilized countries 
show that Bright's disease is increasing very rapidly. 
In the United States the number of persons dying 
of it is at the present time 2.31 times as great as 
thirty years ago. In certain cities the proportion is 
still higher, the increased mortality rate from this 



344 COLON HYG1H.NE 

cause amounting to 164 per cent. The large use 
of meat in connection with this condition of consti- 
pation greatly aggravates the evils arising from this 
condition, because meat not only affords the poison- 
forming bacteria just the sort of material they re- 
quire to promote their growth, but also introduces 
into the intestine in large numbers the most viru- 
lent forms of putrefactive bacteria. 

Suppuration of the kidney, shown by pus in the 
urine as well as by local pains and other symptoms, 
is usually associated with chronic constipation. 
Infection of the kidney with colon germs may occur 
through the urinary tract, the germs travelling by 
the ureters to the kidney, or direct infection may 
occur. The bacteria which grow in the intestines, 
specially when their virulence is increased by stasis 
or stagnation, readily penetrate the walls of the 
intestine and adjacent organs. The right kidney 
lies in immediate proximity to the colon. 

Bacteriological examination of the urine in cases 
of suppuration of the kidney often shows the pres- 
ence of colon germs. 

Movable Kidney 

The right kidney is so closely connected with the 
hepatic flexure of the colon that any change of 
position of this portion of the colon must have more 
or less effect upon the kidney. When the cecum 
and the ascending colon become overloaded, the 



TREATMENT OF DISORDERS 345 

drag upon the kidney may become so great as to 
loosen it from its moorings, and lead to floating 
kidney. 

Disease of the Liver and Gail-Bladder 

Recent observations have shown that when putre- 
fying feces accumulate in the colon great numbers 
of bacteria pass through the walls of the intestine 
into the branches of the portal vein, and are car- 
ried to the liver. The liver destroys many of these 
bacteria, but not a few of them pass out in the bile, 
and thus infect the bile passages of the liver and gall- 
bladder. It is possible, also, that infection may 
occur directly from the intestine. The bacteria may 
ascend the gall ducts to the gall-bladder and the 
liver. Modern research has shown that gall-stones 
are always due to bacteria, which are found in the 
interior of the gall-stones. Persons suffering from 
disorders of the gall-bladder, and from gall-stones, 
are always chronic sufferers from constipation and 
alimentary toxemia, to which unquestionably their 
liver troubles are chiefly due. 

Insomnia 

One very rarely finds a person suffering from 
Insomnia who is not constipated. Not infrequently, 
the constipation is present in the latent form, and 
its existence may not be expected. Examination of 
the stools and inspection of the tongue give clear 
evidence of the existence of stasis in the colon. The 



346 COLON HYGIENE 

insomnia is due to the irritation of the brain cells 
produced by the poisons with which the blood 
is saturated through absorption from the colon. 
The use of soporifics only secures temporary relief 
with a certainty of making the patient worse 
through disturbing his digestion, destroying his appe- 
tite, and thus making his constipation worse. By 
relief of constipation through proper diet, and the 
adoption of other rational measures the insomnia 
may be made to disappear, and usually with very 
great promptness. 

Headache 

This very common and most distressing effect or 
chronic constipation is due to putrefaction poisons 
absorbed from the colon, and constipation quickly 
disappears when the intestinal flora is changed and 
the bowels made to move well three times a day. 
Copious water drinking, especially drinking two or 
three glasses of hot water two or three times a day 
ameliorates the symptom by aiding the elimination of 
poisons. Attacks of migraine are always preceded 
by an increase of stasis, that is, by an accumu- 
lation of fecal matters which throws into the blood 
a new flood of indican and other toxins. By a 
thorough emptying of the colon through the use of 
the enema the attack may always be mitigated and 
sometimes averted. If the attack has actually be- 
gun, however, the result is less satisfactory although 



TREATMENT OF DISORDERS 347 

even then the duration of the attack if not its intens- 
ity may be lessened by emptying the colon by 
repeated enemas. When vomiting or nausea is 
present, the enema should be repeated several times 
a day as a means of introducing much needed fluid. 
An excellent plan is to introduce into the colon to 
be retained and absorbed half a pint to a pint of 
water every hour or two. 

The excruciating pain of migraine may be made 
more endurable by fomentations or alternate hot 
and cold applications to the painful parts. The 
use of morphia and other narcotic or pain retrieving 
drugs is most pernicious. The use of drugs pur- 
chases but present relief at the expense of increased 
future suffering. Such drugs increase the consti- 
pation and so aggravate the toxemia and not infre- 
quently a drug habit is formed. 

Rachitis, Arrest of Growth and Other Dis- 
turbances of Nutrition in Infants 

The researches of Combe and Rouget have clearly 
shown the relation of intestinal intoxication to the 
arrested growth and other disturbances of nutrition 
which are frequently observed in infants and young 
children and that constipation lies at the foundation 
in most of these cases. One of the most important 
of all the duties of the nurse is to attend carefully 
to the condition of the infant's bowels, as neglect 
in the first weeks of infancy may lay the foundation 



348 COLON HYGIENE 

of troubles which years of painstaking efforts will 
be required to relieve, and which may be irrepar- 
able. 

Diverticulitis 

This newly-described disease affects especially 
the colon, and particularly the pelvic colon. It 
consists in the formation of small pouches along the 
border *of the colon, which sometimes increase to a 
considerable size. These pouches become filled with 
feces, which often set up irritation and give rise to 
abscesses. 

Many of these pouches have very narrow mouths 
so that fecal matter readily accumulates in them. 
This condition involves many serious dangers. If 
the mouth of a diverticulum becomes closed, the 
infectious contents quickly give rise to inflamma- 
tion which may result in ulcer of the bowel, abscess, 
or adhesions with the formation of a tumor mass 
and obstruction. When diverticuli are known to 
exist, the patient should take care to keep the bowels 
freely open by a very laxative diet and the use of 
Russian paraffin oil. 

Diverticulitis is caused by injury to the intestinal 
wall produced by colitis followed by overdistention 
of the bowel by accumulation of fecal matters. 

Each diverticulum involves exactly the same dan- 
gers which are connected with a chronically inflamed 
appendix. 

Diverticulitis may cause obstruction of the bowels, 
both by giving rise to adhesions and by causing thick- 



TREATMENT OF DISORDERS 349 

ening of the walls of the intestine, and so gradually 
narrowing its lumen until complete obstruction 
occurs. This condition is sometimes mistaken for 
cancer. 

Cancer 

The discoveries of Ross respecting the cause of 
cancer show very clearly the reason for the special 
frequency of cancer in the pelvic colon and the 
rectum. According to Ross, cancer is due to an 
abnormal stimulation of the processes of normal 
cell growth. He has shown by elaborate laboratory 
researches that cholin and cadaverin, two of the 
products of the putrefaction of flesh or protein, are 
powerful augmenters of cell action, and in recent 
experiments he has been able by these poisons to 
produce in guinea pigs growths which have all the 
characteristics of cancer. Certainly no part of the 
body is more exposed to the influence of these putre- 
factive products than is the lower bowel. It is 
evident, then, that this portion of the body should 
receive prompt attention on the occurrence of the 
slightest symptoms of disease, and that as a protec- 
tive measure putrefaction of the feces should be 
prevented by proper regulation of diet and of the 
bowel movement. 

Tuberculosis of the Bowels 

Intestinal tuberculosis appears to be increasing. 
That this should be the case is not surprising, in 
view of the fact that constipation is becoming more 



350 COLON HYGIENE 

and more prevalent each year. The contact of 
poisonous fecal matters with the mucous membrane 
lowers its resistance and renders it susceptible to the 
infectious influence of the tubercle germ. All forms 
of tuberculosis, as the history of cases shows, are 
almost invariably preceded by chronic constipation 
for a prolonged period. 

Backache 

Aside from symptoms which relate to the rectum, 
backache is perhaps the most common of all local 
symptoms arising from constipation. In women 
this symptom is usually attributed to disease of the 
womb or ovaries. It is safe to say that in by far 
the larger number of cases the pain is due not to 
disease of the organs peculiar to women, but to a 
diseased condition of the colon, set up by long con- 
tinued contact with putrefying fecal matters. In 
many cases tender points can be felt by deep pressure 
along the iliac or the descending colon. Sometimes 
the pelvic colon may be located. By the aid of the 
X-ray and the fluoroscope it is possible to locate and 
make pressure upon every part of the colon, as well 
as to note its form and size, and thus the presence of 
disease may now easily be located when present. 

The pain is reflex in character, and may often be 
produced by pressure upon a contracted and tender 
part of the colon. Pains over the sacrum are quite 
as often due to disease of the rectum as to disease 
of the uterus or ovaries. As constipation is so con- 



TREATMENT OF DISORDERS 351 

stantly associated with disease of the pelvic organs, 
it is a question of interest whether the pain usually 
attributed to pelvic disease, when this is present 
may not in many cases be really due to disease of the 
colon or rectum. Tender spots in the lower part 
of the back are usually due to the same cause, and 
only rarely indicate disease of the spine. 

The congestion of the abdominal organs which 
results from chronic constipation is the cause of a 
great variety of reflex pains in the back and sides. 
Coldness, numbness, prickling and creeping sensa- 
tions, and points of tenderness in the abdomen, a 
sense of weight, dragging and pressure, are only a 
few of the distressing symptoms which arise from 
visceral congestion due to the absorption of toxins 
from the intestinal tract, and the infection of the 
intestinal mucous membrane resulting from chronic 
constipation. 

Exophthalmic Goitre 

This serious disorder, which is becoming con- 
stantly more common, is unquestionably due to 
chronic intestinal poisoning, and hence may be the 
result of constipation, which in some form is always 
present in cases of chronic intestinal autointoxication. 
To treat this malady simply by removal of a part of 
the thyroid gland by a surgical operation, or by 
partial destruction of the gland by the X-ray with- 
out giving attention to its cause, is certainly irra- 



332 COLON HYGIENE 

tional, since the enlargement and activity are the 
effects, no doubt, the absorption of toxins from the 
intestinal canal. The gland enlarges because of the 
extraordinary amount of work demanded of it, its 
special function in the body being to aid in the 
destruction of poisons, especially those developed in 
the intestine by the decomposition of protein. Ani- 
mals whose thyroids have been removed soon develop 
convulsions and die when fed on a meat diet, but 
thrive indefinitely on a diet which excludes meat. 

Myxedema 

A disease which is the antithesis of exophthalmic 
goitre, myxedema, is really due to the same cause. 
The thyroid gland becomes worn out by excessive 
work, and its function is lost. In consequence, the 
whole body suffers from peculiar degenerative 
changes. The skin and hair become dry, pale and 
sodden in appearance, the speech is thick, the expres- 
sion is peculiar and characteristic, and the intellect is 
dulled. The cause of this peculiar disease was 
wholly a mystery until the function of the thyroid 
was discovered. It is now known to be due to the 
failure of this important gland to do its work, as 
the result of degeneration, which is in most cases 
the result of the excessive work imposed upon it by 
the autointoxication induced by a high protein diet: 
that is, by the free use of meat and eggs, especially 
when associated with constipation. 



TREATMENT OF DISORDERS 353 

Hypothyroidism, incipient myxedema, is a very 
common malady. The thyroid is less active than 
it should be though its function is not wholly lost. 
Dryness of the hair, falling of the hair, and dryness 
of the skin are common symptoms of this condition, 
seen associated with chronic constipation, and the 
natural result of long overwork of the thyroid in 
destroying colon poisons. 

Chronic Rheumatism and Rheumatic Gout 
( Osteo- Arthritis ) 

Both these diseases are closely associated with 
constipation and alimentary toxemia. Herter showed 
that certain putrefactive organisms are always pres- 
ent in great numbers in the stools of persons suffer- 
ing from rheumatic gout. The experience of many 
physicians has shown that great improvement often 
follows the adoption of a low r~~"~'n diet in these 
cases; and the benefit derived from securing 
increased activity of the bowels has made many a 
mineral spring famous as a cure-all for rheumatics. 

The writer has seen hundreds of chronic sufferers 
from these maladies greatly relieved and many 
cured by a low protein diet and the restoration of 
normal colon activity. 

Pigmentation of the Skin and Skin Diseases 

When meat and eggs are eaten freely, accord- 
ing to Combe, there may be produced in the intestine 



354 COLON HYGIENE 

a large amount of a brown poisonous coloring sub- 
stance, "brenzcatchin," to destroy which is one of 
the functions of the suprarenal capsules. When 
these glands become defective, through overwork, 
this substance accumulates and, being deposited in 
the skin, gives rise to dinginess of the complexion, 
brown circles around the eyes, so-called "liver 
patches" on the face and other parts, brown spots 
upon the hands, and a deepening of the color of 
parts of the skin which are normally pigmented, 
as the axillary regions, groins, and in many patients 
a line down the center of the back. 

This pigmentation is commonly seen in aged 
persons, in whom as in others its cause is the consti- 
pation which is usually associated with old age. The 
same pigmentation is sometimes seen in young per- 
sons, and even in infants, as the result of intense 
poisoning from intestial putrefaction. When an 
antitoxic diet is aaopted, and the bowels are made 
to act normally, the pigmentation disappears with 
remarkable quickness. Dr. Lane of London has 
demonstrated the connection between this abnormal 
pigmentation and putrefaction in the colon, by 
removing the colon. He states that the worst cases 
show a surprising change for the better in a few 
days, and the pigmentation wholly disappears within 
a few weeks. Cases seen by the writer in a London 
hospital seemed to verify this claim, which is also 
supported by the results of securing frequent daily 
movements in very chronic cases of constipation. 



TREATMENT OF DISORDERS 355 

Eczema 

Eczema, one of the most common and most dis- 
tressing of skin maladies, has long been known by 
skin specialists to be caused by constipation. Doctor 
Bulkley, the eminent skin specialist of New York 
City, has within the last thirty years many times 
called attention to the fact that eczema is encour- 
aged by the use of flesh food, and that most chronic 
cases are curable by strict adherence to a non-flesh 
dietary, even when all other measures have failed 
to give relief. 

A most distressing form of this disease is ec- 
zema of the anal region, one of the frequent re- 
sults of constipation. This annoying ailment usu- 
ally disappears very soon when the bowels are made 
to move three times a day, and meat is excluded 
from the diet. 

Temporary relief from the horrible itching of 
eczema may be obtained in many cases by bathing the 
parts with very hot water (120° F.), or by exposing 
them to hot steam. Then apply an unguent, con- 
sisting of the following: lanolin 2 drams, borogly- 
ceride 1 dram, cold cream 6 drams. This method 
usually succeeds especially well in old cases in which 
the skin is dry or scaly. The eruption usually dis- 
appears very quickly after a proper X-ray applica- 
tion. The actinic ray is sometimes more effective. 
The affected parts should be constantly and very 
carefully protected. 



356 COLON HYGIENE 

Psoriasis 

This form of skin disease, usually more obstinate 
though less distressing than eczema, is generally 
incurable without the adoption of a fleshless diet and 
restoration of the normal function of the colon. 
In many cases nothing else is needed to effect a 
permanent cure. A few applications of the actinic 
rays by means of the arc light or the "mercury light" 
will generally cause the eruptions to disappear. 
Apply the skin cream given on previous page. 

Itching Skin without Eruption 

Many constipated persons, especially old persons, 
suffer from intense itching and burning of the skin, 
especially of the back and other parts of the arms 
and legs. The affection is generally worse in cold 
weather and when hard water is used for baths. A 
soap and water bath is generally followed by an 
increase of the itching. If the skin is scratched, an 
eruption resembling eczema appears. 

Besides combatting the constipation nearly always 
present, bathe the parts with water as hot as can be 
borne (120° F.) several times daily. Avoid rub- 
bing. After bathing, apply skin cream freely. The 
cream should be applied to the whole surface of the 
body after bathing and daily or even twice a day. 
If necessary to completely relieve the itching, men- 
thol may be added to the cream in the proportion 
of ten grains to the ounce. 



TREATMENT OF DISORDERS 357 

Vertigo 

This unpleasant symptom is a very common result 
of constipation. Vertigo is a common symptom in 
cases of arteriosclerosis caused by constipation, and 
sometimes results from irritation produced by the 
presence of feces in the rectum. In certain nervous 
persons, vertigo, faintness or exhaustion are some- 
times experienced when the bowels are evacuated by 
a saline laxative or by an enema. The cause of this 
is doubtless the absorption of poisons brought into 
solution by the large amount of fluid present in the 
intestine. So long as the feces are hard, little absorp- 
tion can take place. But when they become semi- 
fluid, the poisons present are brought into solution 
and are also made to come in contact with the 
mucous membrane, so that rapid absorption occurs. 
In some instances, the prostration is such that recov- 
ery does not take place for several hours. These are 
probably cases in which the liver and kidneys are 
crippled as the result of long-standing disease. 

Dr. Case has observed that unpleasant symptoms 
immediately following an enema are connected with 
the entrance of the injected liquid into the small 
intestine through an incompetent ileocecal valve. 
This is an interesting observation. It suggests that 
vertigo at other times may be due to refluxed ma- 
terial from the colon, due to antiperistaltic action of 
the colon. The wretched feeling which many 
neurasthenics experience in the morning may be; 



358 COLON HYGIENE 

due to the same cause. Case has observed that 
although the small intestine may be entirely empty 
at night, in the morning several feet of the intestine 
may be filled with fecal matters which have returned 
from the colon through an incompetent ileocecal 
valve. 

Disorders of the Urinary and Generative 
Organs 

Urinary troubles in both men and women, as well 
as in children, are often traceable to constipation. 
Very foul-smelling urine often owes its unnatural 
odor to the presence of putrefaction poisons absorbed 
from the intestine. 

Both inability to urinate and a frequent desire to 
urinate may result from the accumulation of feces 
in the rectum. In children the escape of urine dur- 
ing sleep is often due to constipation. 

Prolapse and retroversion of the uterus is a com- 
mon result of the straining necessitated by constipa- 
tion in women and girls. 

Dysmenorrhoea, leucorrhoea, and a varicose con- 
dition of the broad ligaments, which is accompanied 
by much pain and discomfort, may result from the 
pressure of feces in the rectum and lower colon. 
Nocturnal seminal losses and an abnormal irritabil- 
ity of the parts, causing erection and also neuralgic 
pains in the testicles, and varicose veins, may result 
from the congestion caused by the pressure of feces 
in the rectum and lower colon. 



TREATMENT OF DISORDERS 359 

Fecal Fever 

Accumulation of feces in the colon is a frequent 
cause of attacks of fever which so much resemble 
malarial paroxysms that they are usually treated by 
the administration of quinine. There is often a 
distinct chill, followed by fever and sweating. The 
tongue is coated, the breath bad, and there is much 
headache, and sometimes vomiting. The fever may 
last several days, but disappears quickly when the 
bowels have been thoroughly evacuated. 

These attacks are very common in persons who 
are subject to colitis, and much mucus is often dis- 
charged when the bowels are cleared out. 

Abdominal surgeons have constant occasion to 
note the effect of fecal accumulations in raising the 
temperature. A rise of temperature after operation 
is more often due to this cause than to any other. 
This fact led to the practice of thoroughly evacuat- 
ing the bowels before operation, and early moving 
them afterwards, an innovation introduced by the 
late Dr. Lawson Tait, and which has been the means 
of saving more lives than any other modern improve- 
ment in surgery, except aseptic technic in operation. 

Neglect to secure complete and regular evacuation 
of the bowels is a frequent cause of rise of tempera- 
ture after confinement and in convalescence from 
acute illness. Accumulation of feces not infre- 
quently occurs when the bowels move daily, and 
even when the bowels are quite loose, as shown by 



360 COLON HYGIENE 

the immense quantities of loathsome material which 
may be washed out by means of a thorough enema. 
The writer recalls a case in which a woman who 
had very loose movements for two or three weeks 
was found to have an enormous mass of hardened 
fecal matter in the rectum, and a very great accumu- 
lation of feces in the lower colon. 

Bed patients should always be made to sit up 
when moving the bowels or urinating, when this is 
at all possible, so as to secure complete evacuation of 
the urine and feces. In most cases this may be done 
without injury after the second day. The same 
remark applies with special interest to cases of con- 
finement. There is so often an accumulation of feces 
in the colon in pregnancy, especially within the last 
two or three weeks before confinement, that it is 
highly important to give the matter prompt atten- 
tion at once after the child is born, as well as before 
confinement. Very often a great quantity of putre- 
fying material will be removed, the retention of 
which may give rise to autointoxication with fever 
and even worse symptoms. 

Flatulency 

This symptom may result either from the exces- 
sive formation of gas in the intestine, or from the 
accumulation of gas. A certain amount of gas is 
natural. The presence of gas in the intestine is 
an aid to peristalsis. This is especially true of 
the large intestine. 



TREATMENT OF DISORDERS 361 

Excessive formation of gas occurs through 
the action of bacteria upon the food stuffs. Gas 
is most readily formed from cooked starch or sugar, 
but may be formed from cellulose and from pro- 
tein. Odorless gas is usually formed from starch 
or sugar, inflammable gas from cellulose, and gas 
having a foul odor from protein. These different 
elements of the food are acted upon by different 
species of bacteria, so that the character of the gas 
formed in the intestine becomes something of an 
index to the sort of bacteria present. Bacteria 
which act upon starch, sugar and cellulose are com- 
paratively harmless while the presence of foul 
smelling gases indicates the presence of putrefaction 
and the pernicious bacteria and the virulent poisons 
which are always present in this condition. 

The formation of gas in excess is due primarily 
not so much to the excessive use of starchy food, as 
many persons suppose, but to stasis or stagnation 
of the food. Bouchard showed long ago that if the 
foodstuffs remain in one part of the alimentary 
canal, even in the stomach, fermentation and other 
bacterial changes take place. 

An important remedy for flatulence, then, is in- 
creased intestinal activity. When the gas is confined 
to the colon an enema, either warm or cool, will 
usually secure relief; for permanent relief the 
causes of the constipation must be removed by sys- 
tematic treatment. 

Flatulence which is not relieved by emptying the 



362 COLON HYGIENE 

colon is due to incompetency of the ileocecal valve. 
The absence of the check valve at the junction of 
the small intestine with the colon permits the gas 
to pass back into the small intestine. This condition 
is generally greatly mitigated by increased activity 
of the bowels; a radical cure may be accomplished 
by repairs of the ileocecal valve. 

Flatulence may become dangerous in cases of high 
blood pressure with degeneration of the blood ves- 
sels. The great accumulation of gas in the intestines 
forces the blood out of the abdominal vessels into 
the general circulation, and so raises the blood 
pressure. If the blood pressure is already high, and 
the blood vessels seriously weakened, the rise of 
pressure may be sufficient to cause a rupture and 
apoplexy with paralysis, if the rupture occurs in the 
brain. 

The wet girdle or moist abdominal bandage is 
often found a most efficient means of combating 1 
flatulence. The bandage must be kept moist, and 
should not be too warmly covered. The mackintosh 
cover must be omitted, the purpose being to promote 
evaporation and thus maintain a mild stimulant 
action upon the intestine. The bandage will dry 
out in three or four hours, when it should be 
renewed. It may be worn with advantage 
both night and day. The bandage must be changed 
or boiled daily to avoid producing skin infection. 

Flatulence in the colon always means stasis, that 
is, delayed feces which need removal. Persons who 



TREATMENT OF DISORDERS 363 

have been accustomed to a hearty meat diet some- 
times suffer considerably from flatulence when a 
change is made from meat to vegetables, but this 
should not be considered as a need to return to a 
highly nitrogenous diet. After a short time the 
activity of the bowels will be increased to such a 
degree that the constipation will be overcome, and 
the flatulence will disappear. In cases in which the 
free use of cereals or starch food is accompanied by 
acidity of the stomach or heartburn soon after eating, 
the difficulty may be relieved by increasing the 
amount of fat taken with the meals. Usually one 
or two tablespoonsful of olive oil taken at the be- 
ginning of the meal will cause the disappearance 
of this unpleasant symptom. 

Foul Tongue and Bad Breath 

These common conditions are more often due to 
constipation than to neglect of the mouth. A high 
protein diet, that is the free use of eggs and meats, 
together with constipation even in very mild degree, 
will cause coating of the tongue and a fecal odor 
of the breath. The general low resistance caused 
by chronic toxemia destroys the ability of the saliva 
to prevent the growth of germs in the mouth and 
the result is coating of the tongue, ulceration of the 
gums and decay of the teeth. 

The cure is not to be found in dentifrices, lotions, 
tooth brushes or dental procedures, "mouth treat- 



364 COLON HYGIENE 

ment," etc., but in removal of the cause by 
draining the bowels through diet and other 
measure, to move thoroughly three times daily. Of 
course the toilet of the mouth and "mouth treat- 
ment" by a skillful dental surgeon must not be 
neglected. 

A diet consisting exclusively of wheat bran and 
fruit, preferably apples and oranges, continued for 
three or four days will rapidly clear the tongue and 
sweaten the breath in ordinary cases. Half a pound 
of sterilized bran should be eaten daily and apples 
may be eaten in any quantity which does not cause 
inconvenience. Twelve to sixteen apples taken at 
four meals will usually be found sufficient. The 
fruit must be eaten raw and should be well chewed. 
One or two apples or other fruit may be eaten 
whenever a craving for food is felt. Fruit imposes 
little or no labor upon the digesive organs. Berries, 
grapes, peaches, oranges, melons, tomatoes, lettuce 
cucumbers and celery may be added to the bill of 
fare if desired. The greater the bulk and the less 
the actual food value represented in the food the 
better. 

The addition of bran is necessary for the reason 
that the tender cellulose of fruit is often almost 
completely digested and so furnishes little residue. 

The "milk regimen" conducted according to the 
author's method (see pages 188-190), for one to 
two weeks rarely fails to clear the tongue and to 
remove the foul odor of the breath. 



TREATMENT OF DISORDERS 365 

Hemorrhoids 

The pain and inconvenience from hemorrhoids 
is usually the result of infection. The distended 
veins do little harm unless inflamed. The infection 
results from the retention of fecal matter in the 
folds of the mucous membrane. Straining at stool 
distends the veins and cracks the mucous membrane, 
thus opening up channels for infection. Abrasions 
are also often produced by rough toilet paper and 
by lack of care in the insertion of the enema tube. 
Thorough cleansing of the parts with water after 
bowel movement is an excellent preventive measure. 
This is the universal custom in India and is certainly 
more sanitary if less convenient than the method 
in universal use in western countries. The use of 
an antiseptic suppository after each bowel move- 
ment is a most useful precaution. Suppositories 
made of cocoa butter and containing two grains 
each of tannic acid are most excellent for this 
purpose. 

When the bowels move freely three or four times 
a day hemorrhoids are rarely troublesome, at least 
when the precautions above recommended are em- 
ployed. In many cases they apparently disappear. 
When persistent however, they should be removed. 
This may be done with perfect safety and with 
so little inconvenience that no one who suffers from 
hemorrhoids should hesitate to have them removed. 
Chronic irritation is an invitation to cancer. 



366 COLON HYGIENE 

Anal Fissure or Ulcer 

This painful affection most generally follows 
hemorrhoids. If it does not speedily disappear 
when the bowels become regular, resort to operation 
is necessary. Operation is also indicated when the 
ulcer renders defecation painful and thus interferes 
with regular bowel action, which is most generally 
the case. 

The operation need not be dreaded. The 
modern methods of dealing with surgical cases of 
this sort are entirely safe and nearly painless. 

Anal Itching 

This is usually a form of eczema which is kept 
up by an irritating discharge from the rectum. The 
measures recommended for eczema will effect a 
speedy cure after the bowels have been regulated 
and the rectal irritation or proctitis has been cured, 

Rectal Prolapse 

In cases of prolapse of the rectum frequent 
movements of the bowels are necessarily avoided on 
account of the inconvenience involved. Such cases 
may be cured by a simple and safe surgical pro- 
cedure. Such an operation should be the first step 
in the effort to cure the chronic constipation present 
After the operation, the free use of bran and paraffin 
at each meal will prove efficient. 



TREATMENT OF DISORDERS 367 

Anal Incontinence 

Persons whose anal sphincters have been para- 
lyzed by disease or by careless surgery often keep 
the bowels constipated to avoid annoyance from in- 
continence. In such cases it is of course necessary 
first of all to remedy the anal defect. This may 
usually be done by a skillful surgeon and the opera- 
tion is attended by no serious risk. 

Anal Spasm 

Undue contraction of the anal sphincter is 
generally associated with fissure, hemorrhoids or 
rectal irritation. If not speedily relieved by removal 
of the source of irritation the operation of stretching 
the sphincter is necessary. Excessive tension of the 
sphincter appears to be sometimes present without 
evidence of local irritation. 

Abdominal Tenderness 

Very hot fomentations applied two or three times 
a day for ten or fifteen minutes are almost a 
sovereign remedy for the abdominal tenderness 
usually found in chronically constipated persons, 
especially when colitis is present. The moist ab- 
dominal bandage used at night with a mackintosh 
cover is a very old-fashioned and still unrivalled 
remedy for tenderness, soreness and ill-defined pain 
in the abdomen. These remedies are more than 



368 COLON HYGIENE 

merely paliative, but of course are not in themselves 
curative unless the constipation which gives rise to 
the congestion of the sympathetic nerve centers, to 
which the pain is due, is also cured by use of the 
proper means. 

Colic Pains 

Apply very hot fomentations to the abdomen and 
administer a hot enema. Repeat the applications 
both of the fomentations and of the hot enema until 
the pain ceases as it soon will do. Heat is a most 
excellent antidote for pain. It also relaxes muscular 
spasm; it is thus a most appropriate remedy for 
intestinal colic. 

"Kinks" 

So much is being said about "kinks" in current 
medical literature it is not remarkable that the laity 
should begin to take an interest in the subject. The 
writer's chief purpose in mentioning this subject 
here is to emphasize the fact that "kinks" are of 
far less consequence than was at first supposed. 
X-ray evidence has demonstrated that kinks and 
folds in the colon are seriously obstructive only in 
very rare cases. To advise a surgical operation 
simply because the X-ray shows a "kink" or fold 
in the transverse colon or a very pronounced pro- 
lapse is most improper. It has been proved that 
the so-called "Lane's kink" of the terminal ileum 



TREATMENT OF DISORDERS 369 

is seldom a source of trouble and very rarely re- 
quires surgical interference. By the adoption of 
an atoxic diet from which all animal protein is 
excluded and by the employment of the necessary 
measures for securing three bowel movements daily 
the troubles supposed to arise from "kinks" rarely 
fail to disappear; and without the adoption of these 
measures surgery affords only temporary relief, 
sometimes not even that, as a return for the very 
great risk to life and the severe suffering and shock 
involved in such operations as "short circuiting" 
and removal of the colon. 



Bowel Habits of Uncivilized Man 

Civilized human beings have departed so far from 
natural primitive modes of life, and have adopted 
so many unph}-siologic practices, that it is quite 
impossible from the conventional usages of civilized 
people, to form any just conclusion of what are nat- 
ural or biologic modes of life for human beings. 
This is particularly true of customs and habits in re- 
lation to human alimentation. From a study of the 
modern hotel bill of fare one could not possibly 
obtain even a suggestion of man's primitive and 
biologic diet. The natural conclusion would be 
that man is a universal feeder, since the average 
hotel menu presents practically everything that any 
animal eats; but biology teaches us that man is 
naturally frugivorous, and science offers no reason 
why he should have departed from his original bill 
of fare, to which his nearest relatives, the anthro- 
poid apes, the chimpanzee, the orangoutang and the 
gorilla, living in their native forests, still scrup- 
ulously adhere. 

Man has not only developed wrong habits in 
relation to the kind of food he eats, but has become 
unbiologic in almost every phase of his daily life. 
Constipation is simply one of the natural conse- 
quences of these perversions. It is scarcely too much 
to say that the average civilized man is the victim 
of chronic constipation. If his bowels move once 

370 



BOWEL HABITS OF UNCIVILIZED MAN 371 

a day, or even once in two days, he feels that his 
condition is very satisfactory; whereas Cannon, in 
his work entitled "The Mechanical Factors of Di- 
gestion," has shown that practically all the digestible 
food taken at an ordinary meal is digested and 
absorbed within eight or nine hours from the time 
it is eaten, and the unuseable residue is at the end 
of this period found deposited in the colon, ready 
for ejection. Since the chief business of the colon 
is to eject wastes from the body, why should the 
performance of its function be so long delayed? 
The colon contents are largely made up of bacteria 
and excretory products, the undigestible elements 
of the food constituting only about one-half its 
bulk, while starch, fats, and protein are found in 
only very small and negligible quantities. It should 
be remembered that bowel movement is not simply 
for the purpose of discharging the unuseable residues 
of food. An equally essential reason for bowel 
movement is the discharge of the bile and other 
highly poisonous excretions which are discharged 
into the colon from the blood. No possible good, but 
only much harm, can come then from the prolonged 
retention of these body wastes and unuseable resi- 
dues. There is in fact no physiologic reason why 
food residues should be retained in the body more 
than twelve to eighteen hours, or at longest twenty- 
four. It is evident, then, that bowel movements 
should occur at frequent intervals, for the purpose 
of removing these waste and poisonous materials. 



372 COLON HYGIENE 

The natural intestinal rhythm, as has been 
previously explained, provides for an unloading of 
wastes by a bowel movement after each meal and 
sometimes an additional one on rising. This requires 
three or four bowel movements daily. Although 
convinced by careful and extended observations in 
dealing with many thousands of invalids, that the 
bowels should be made to move several times a day, 
the writer several years ago set about collecting 
from original sources facts concerning the habits 
of uncivilized tribes of human beings. 

The keeper of the London Zoological Gardens, 
informed the writer that the chimpanzee, orang, and 
the other large apes move their bowels four times 
daily with perfect regularity. Professor Hornaday, 
superintendent of the Bronx Park informs us that 
the large apes in the great collection under his super- 
vision move their bowels three times a day. 

Extensive inquiries made by means of a question- 
aire sent out to physicians practising among primi- 
tive people in various parts of the world, show that 
the custom among many of those who live in a 
really primitive state, and have been little influenced 
by contact with civilization, is the same as that of 
the higher apes. Replies were received from one 
hundred and forty physicians who have had abun- 
dant opportunity to become acquainted with the 
habits and usages of the wild or half civilized people 
with whom they have been closely associated, and 
among whom they have practiced for years. A sum- 



BOWEL HABITS OF UNCIVILIZED MAN 373 

mary of these replies will be found highly interest- 
ing, especially in the light of the physiological facts 
which have been presented in the previous pages. 
It is most instructive to find wild and primitive 
people in widely separated portions of the globe 
following identical usages to which they have been 
trained by Nature, the universal teacher. A com- 
mon instinct has led to a practical uniformity of 
habits among wild tribes who have not yet been 
sophisticated and perverted by contact with civiliza- 
tion. It is interesting also to note the same identity 
between wild tribes and those most remarkable 
creatures of the tropical wilds, the anthropoids, in 
practices connected with eating and bowel action. 
For much valuable and interesting information, a 
small portion of which is summarized in this 
chapter, I am indebted to scores of missionary phy- 
sicians who have devoted their labors to the noble 
work of civilizing and Christianizing the people of 
heathen lands. 

From the original and authentic information the 
fact appears that among tribes which have been un- 
influenced by the customs of civilization, who still 
adhere to primitive habits in diet, and who live a 
free and active life in the wild, the bowels move 
two or three times daily. A single daily movement 
is regarded by such people as constipation, and gives 
rise to alarm. The one-movement-a-day habit ap- 
pears only among those classes or castes who live 
a sedentary life and have adopted unnatural habits 



374 COLON HYGIENE 

in diet, such as the use of hot condiments, concen- 
trated food, etc. The aristocratic classes of India 
and China afford striking examples of this, suffering 
much from constipation in consequence of their idle 
and luxurious habits, and from the use of curries 
and other unwholesome condiments, while the 
working classes whose diet and habits are more 
nearly normal are generally exempt. 

As regard the frequenq^ of bowel movements, 
physicians located in the following countries, re- 
ported the usual custom to be two or more daily, 
usually two, for the very good reason that two meals 
only are eaten, the first movement being on rising, 
or after the first meal, and the second soon after 
the second meal, or before retiring: 

Rhodesia, Uganda Protectorate, Nyassaland, Ni- 
geria, Harda (India), Delhi (India), Punjab (In- 
dia), Kashmir, Nagpur (India), Bawda (India), 
Persia, — three or four times in summer when fruits 
are plentiful. Aintab (Turkey), Harpoot (Tur- 
key), West Coast of Africa, — two or three. Portu- 
guese Congo, — two or three. Egypt, — children 
four or five. Japan, Arabia, — two or three. 

It is interesting to note that the experience of 
the millions of primitive and half-civilized people 
who inhabit the above named countries demonstrates 
perfectly that an intake of food should be soon fol- 
lowed by an output of food residues and wastes. 

In all these countries, as among practically all 



BOWEL HABITS OF UNCIVILIZED MAN 375 

primitive people, great attention is given to the 
bowels. The mothers carefully train their children 
to move their bowels at regular times, and much 
pains is taken to make the diet such as to promote 
intestinal activity. The virtues of fruits and green 
vegetables are fully appreciated, and where rice 
is the principal food, as in most of the Orient, large 
use is made of green vegetables. 

It is especially of interest to note the frequency 
with which some custom in relation to bowel hygiene 
is found in vogue among primitive people who have 
practiced it from time immemorial, while among 
civilized people the same practice has only recently 
become known as one of the discoveries of modern 
medical science. It is becoming more and more 
evident that our modern civilization in emerging 
from barbarism has left behind much that was not 
only useful but essential to a healthy physical life, 
and we may therefore profit by a careful study of 
the habits of primitive people and even of those wild 
animal species which belong with man in the class 
of primates, and are closely allied to the human 
species in structure and function. 

Here are a few extracts from the replies to our 
questionaire, which will be found most instructive 
as well as interesting: 

"I am of the opinion that diet has a great in- 
fluence. The Labances eat plenty of figs, either 
alone or mixed with juice of grapes or juice of carob 
fceans, brown bread, fruits, vegetables, olive oil, 



376 COLON HYGIENE 

olives, etc., and drink plenty of spring water at 
meal times." — A. J. Manasseh, M. D., Bruana, 
Beyrout, Syria. 

"Laxative foods used are the following: Cooked 
manioc leaves, bananas, pineapples, bingondia (a 
sour-sweet seedy fruit), plantains, peanuts, palm 
oil, pumpkin seeds mashed and cooked. Raw guava 
leaves are used for diarrhoea, also the clay mounds 
built by white ants." — Mattie and P. Frederickson, 
Belgian Congo, West Central Africa. 

It is interesting to note that the most primitive 
tribes of savages have recognized the importance of 
regular and frequent bowel action and provided for 
the maintenance of this important function by in- 
cluding in their dietary special laxative foods such 
as named above. This usage is practically universal 
among wild tribes in all parts of the world. 

"In the Cape Colony the staple food is stamped 
maize and sour milk; the absence of the sour milk 
leads to constipation. In the Northern Transvaal 
the staple food is thick maize porridge, sour milk, 
and, in summer, green vegetables. People go more 
often (i. e.j say three times a day) when taking 
both vegetables and milk. When these are scarce, 
they may go only once." — Neil Macvicar, M. D., 
Lorendall, South Africa. 

It is especially interesting to note that the Cape 
Colony natives have by experience learned to ap- 
preciate the value of sour milk as a laxative food 
and corrective of intestinal disorders. Several Af- 



BOWEL HABITS OF UNCIVILIZED MAN 377 

rican travelers have called attention to the fact that 
among the native tribes of Africa milk is generally 
used in the soured state. The custom is to put the 
milk into a gourd at night which is reserved for 
this particular purpose. In the morning the milk 
is soured and ready for use. At night a new sup- 
ply of milk is put into the empty gourd which is 
never washed and so preserves the lactic-acid-form- 
ing ferment in an active state. 

"The natives are, in Toro, almost entirely vege- 
tarians, living on millet or plantains or beans. 
They rarely get meat. In 9642 out-patients seen 
during the last seven months of 1911, there were 
174 cases of constipation, one and eight-tenths per 
cent of the whole." — J. Howard Cook, M. D., 
Uganda Protectorate, East Africa. 

In this country the percentage of patients in 
whom constipation is present is just the reverse of 
that in Uganda. Whereas in Uganda there are 
less than two per cent who are constipated, in civ- 
ilized countries among sick people there is scarcely 
one in a hundred who is not constipated. 

"The rather coarse diet, largely grains and vege- 
tables, has a favorable influence on the bowel move- 
ments. The stools are usually very large and fairly 
soft."— A. H. Norton, M. D., Haiju, Korea. 

"The people eat large quantities of rice, turnips, 
peppers, roots, vegetables and little meat. The 
large quantity of residue must act as a stimulus to 
peristalsis." — W. C. Purviance, M. D., Chung Ju, 
Korea. 



378 COLON HYGIENE 

"Cereals, as wheat, barley, oats, millet seed, and 
all kinds of vegetables, are the staple food here 
(extreme north of Korea) ; very little fish and lass 
meat is eaten." — F. H. Birdmann, M. D., Dotson, 
Korea. 

The natives of Korea like those of China and 
Japan are generally known as rice eaters. It is in- 
teresting to note that the natives of Korea make 
large use of turnips and vegetables and little use of 
meat. Flesh foods are unquestionably constipating 
in their nature, not only because they are completely 
digestible, leaving little residue behind, but because 
the putrefaction to which they give rise results in 
the formation of ammonia and other alkaline sub- 
stances which paralyze the bowel. "Meat bacteria" 
which swarm in all kinds of flesh foods are also a 
prolific cause of colitis, which by causing spastic 
contraction of the descending colon and the pelvic 
colon, produces mechanical obstruction to bowel 
movement, and also as shown by Dr. J. T. Case, 
induces powerful retro-peristaltic contractions by 
which the intestinal contents are forced back into 
the right half of the colon. The cecum and as- 
cending colon become greatly dilated as a result, 
and in time the cecum becomes movable and pro- 
lapsed. The stretching of the colon enlarges the 
ileocolic junction until the ileocecal valve becomes 
incompetent, thus establishing the condition known 
as intestinal toxemia with its long train of evil con- 
sequences. The vegetarian habits of the people of 
Korea are without doubt of great service to them 



BOWEL HABITS OF UNCIVILIZED MAN 379 

in enabling them to successfully combat the highly 
unsanitary conditions under which they live. 

"Bowel movement full and frequent among the 
working people, who eat large quantities of vege- 
tables ; more disturbed among the better classes, who 
eat more meat." — J. K. Cox, M. D., West China. 

"My experience with patients has been that they 
are not so subject to constipation as persons in the 
U. S. whom I have treated. Think probably the 
free use of greens and other vegetables has some- 
thing to do with the difference, as well as not post- 
poning the call of Nature, as is done by civilized 
persons." — Ida M. Scott, M. D., Tak Hink Chan, 
South China. 

"The vast majority of the people live on coarse 
grains and coarse vegetables, which are favorable 
to large bowel movements." — Geo. D. Lowry, 
M. D., Peking, China. 

"In my own case, going onto a purely local diet 
of rice and coarse vegetables is usually accompanied 
with looser motions." — George Hadden, M. D., 
Yung-an Fookin Pwo., China. 

"Rice is the principal diet, but is usually accom- 
panied by considerable quantities of vegetables, 
largely what we call greens. The Chinese have a 
great variety of leaves and stocks that are used for 
greens, such as cabbage, lettuce, and many other 
kinds that we do not see in America. With this 
diet and exercise, the healthy Chinaman usually has 
free bowel action. I think the 'greens' is a very 



380 



COLON HYGIENE 



suitable diet for this climate." — Jean McBurney, 
M. D., Cheung Chow, Hong Kong,' China. 

"Foods coarse, and largely vegetable, especially 
among the country people, which means four-fifths 
of the population. Chinese are not meat eaters to 
a great extent." — F. F. Tucker, M. D., Pangkiach- 
wang, Shantung, China. 

"The natives eat much vegetables, which regu- 
late the bowels." — Cecil I. Davenport, M. D., 
Shanghai, China. 

The people of China as well as those of Korea 
are evidently protected from the natural constipat- 
ing tendency of a rice diet by the free use of coarse 
vegetables. The large use of vegetables of all sorts 
which is practiced in the Orient is generally for- 
gotten by those who call attention to the fact that 
rice is the staple foodstuff in this part of the world. 
It is true that rice is the chief source of nutriment 
but at the same time nature has taught these people 
to make ample provision for the bulk which is es- 
sentially to stimulate normal peristalsis by the use 
of greens and vegetables of all sorts. Vegetables 
are used not only during the summer months but 
at other seasons also. Turnips and several other 
roots are preserved by pickling in salt brine as cu- 
cumbers are preserved in this country. A very large 
use is also made of bamboo sprouts, of the leaves 
and roots of certain lilies which are preserved by 
drying and of several varieties of seaweed, from 
some of which a gelatinous substance known as Jap- 
anese isinglass or agar-agar is made while others 



BOWEL HABITS OF UNCIVILIZED MAN 381 

are used in their native state as Iceland moss and 
Irish moss are used in this country. 

"The natives note that in eating pumpkins and 
prunes they have more bowel movements. An old 
man told me that if a person, early in the morning 
before taking any food, eats ten fresh prunes from 
the tree, he'll have bowel movements easily." — G. 
Yeram, M. D., Gumaldjine, Turkey. 

The most primitive people have learned by ob- 
servation the importance of bulk, a lesson which has 
yet to be learned by the great majority of people in 
civilized lands. Knowledge of the laxative value 
of fruits, especially of prunes is, however, quite 
widely diffused. The Turkish peasant who told 
our friend Dr. Yeram that ten fresh prunes taken 
from a tree would produce a laxative effect was 
perhaps not aware however, that dried prunes may 
be so freshened by soaking in cold water for 24 
hours that their laxative quality is to a large ex- 
tent restored. The free use of raw soaked prunes 
is a highly valuable food remedy for constipation 
which has long been in use by many European and 
American physicians. 

"The principal food of both city and rural popu- 
lation of the region is boolghoor (cracked wheat, 
which has been cooked, dried, and the thin outer 
skin removed before cracking. It is cooked in many 
ways. The commonest is to boil it about ten min- 
utes, and add a little melted butter before serving) , 
and coarse bread of wheat or barley, varied by len- 
tils and other legumes, and the fermented milk of 



382 COLON HYGIENE 

the country (yougurt in Turkish, leben in Arabic, 
or matzoon in Armenian). The village people eat 
considerable fruit, especially grapes in season, but 
very little meat or vegetables. The city dwellers 
eat a good deal of meat and vegetables, more fruit, 
and less youghurt than the villagers. They also 
eat finer bread and more spices and condiments. In 
general, I may say that constipation is relatively 
much less common than in America, and much less 
common among the villagers than the city people; 
in fact, very seldom seen in those who eat boolghoor. 
The posture assumed in defecation may also have 
something to do with it. They never sit on a stool, 
but always use the natural, squatting posture. In 
the city, where they have regular privies, the ar- 
rangement is a slit or opening in the floor, over 
which the person squats. The universal habit is to 
move the bowels three times a day." — F. D. Shep- 
ard, M. D., Aintab, Turkey. 

The above interesting account of the dietetic hab- 
its of the people of Turkey kindly sent us by the 
late Dr. Shepard contains enough practical hints 
about dietetic methods of combating constipation to 
enable almost any practical person to formulate for 
himself an efficient and laxative dietary. It is evi- 
dent that however much we may be in advance of 
the ignorant Turkish peasant in the various forms 
of culture which together make up what we call 
civilization, we may study his methods in diet with 
great profit. 

The matter of the position in sitting at stool to 



BOWEL HABITS OF UNCIVILIZED MAN 383 

which Dr. Shepard also called attention is one of 
no small importance. We are learning more and 
more the importance of making a careful note of 
the hints which nature gives us in the instinctive 
leadings of animals and human beings living in a 
wild or primitive state which have resulted in the 
formation of customs and habits, the essential re- 
lation of which to our physical welfare has been 
heretofore too much disregarded. 

In all parts of Turkey, it is the custom of the 
people to move the bowels three times daily which 
is the natural result of the use from early child- 
hood of the several laxative foods above mentioned. 
Of this we are assured by a personal statement made 
to the writer by the late Dr. Shepard who was 
most intimately acquainted with the habits of the 
Turkish people through living and practicing among 
them for more than thirty years. That the custom 
of tri-daily bowel movement is common to all 
classes is shown by an incident related to the writer 
by the eminent Sir Arbuthnot Lane of London, 
England. The famous surgeon was one day con- 
sulted by an official from the Turkish Embassy in 
London who desired relief from constipation. When 
asked for a particular account of his symptoms he 
admitted that his bowels moved once a day but 
declared that he was greatly constipated and not 
half a man, and that when his bowels moved three 
times a day his vitality and stamina were more than 
doubled. 

"Yoghurt is the form in which milk is taken 



384 COLON HYGIENE 

in Persia. We rarely see appendicitis in the natives. 
I often wonder whether the yoghurt may be the 
preventive. The common people live on yoghurt, 
cheese, bread, and fruit. Meat only occasionally. 
They all consider milk (not yoghurt) a laxative, 
and so it seems to be for the natives." — W. S. 
Vaunemann, M. D., Labriz, Persia. 

It is certainly very interesting to note that the 
custom of using sour milk should be nearly uni- 
versal among the hundreds of different tribes and 
nations filling the vast territory from the southern 
tip of the dark continent to Persia. It is also in- 
teresting to observe a verification of the observa- 
tions made some years ago by Dr. Senn who studied 
the people of the east coast of Africa and noted the 
absence of appendicitis, an observation also con- 
firmed by Dr. Lucus-Champonniere of France, who 
found appendicitis very rare among the wheat- and 
date-eating Arabs of Algiers, and among the inmates 
of prisons and insane asylums in France where meat 
is rarely made a part of the bill of fare. 

"The diet seems to favor looseness, since it con- 
sists largely of coarse bread from unbolted flour; 
also in summer of large quantities of fruit in- 
gested." — J. A. Funk, M. D., Hamadan, Persia. 

The use of superfine white flour appears to be 
almost wholly confined to civilized nations and 
there can be no doubt that to this practice is largely 
chargeable the almost universal prevalence of con- 
stipation in countries which claim to be the most 
advanced in civilization. 



BOWEL HABITS OF UNCIVILIZED MAN 385 

"It is a common saying among them that milk 
acts as a laxative, especially if freshly milked and 
unboiled."— P. W. Brigstocke, M. D., Jerusalem, 
Palestine. 

The fact that boiled milk is constipating has long 
been recognized in this and other civilized countries. 
It appears that the same fact is known to the un- 
educated natives of Syria. It is only recently that 
science has offered the explanation which has been 
supplied by the bacteriological laboratory that boiled 
milk undergoes putrefaction in the intestine because 
of the destruction of the acid-forming bacteria which 
abound in raw milk which has been exposed to the 
air, and stimulate bowel action and prevent putre- 
faction. 

"The diet is largely a vegetable and cereal one, 
meat being eaten only occasionally." — A. F. Grant 
M. D., Assiut, Egypt. 

It is instructive to note that the Egyptians are 
still as in ancient times practically non-flesh eaters. 
The experience of two or three thousand years has 
not convinced these simple tillers of the soil that 
the natural products of the earth are not capable 
of affording ample and sufficient nourishment. The 
fertile valley of the Nile in centuries far remote 
from the present supported a population perhaps 
more dense than has been maintained in any other 
part of the world. It may be that some future time 
will again see this highly favored region teeming 
with human life and enterprise, supported as of old 
by the products of its marvelously fertile soil. 



386 COLON HYGIENE 

"The coarse simple diet — millet or corn porridge 
or bread, cabbage, soup, etc. — of the country seems 
to favor regularity of the bowels." — Mrs. Estella 
A. Perkins, M. D., Pao Ting, China. 

"The almost exclusive vegetable diet — rice, cab- 
bage, etc., — seems on the whole to be favorable, and 
constipation is not so common among the sedentary 
classes as might be expected." — B. S. Browne, 
M. D., Ningpo, China. 

"Constipation is not common, but the inhabitants 
of Manchuria are mostly vegetarians, i. e., eat little 
butcher meat except on festive occasions." — Drs. 
Christie and Muir, Mukden. 

"People suffering from diarrhoea frequently take 
rice and 'dahi' (curds, sour milk), to check it. 
Ordinary milk they generally consider constipat- 
ing." — N. C. Henderson, M. D., India. 

A specimen of dahi sent us by a friend from 
Darjeling was found to be practically identical with 
the yoghourth of Bulgaria, the matzoon of Armenia 
and the leben of Egypt. The so-called Bacillus 
Bulgaricus is apparently the active acid producer 
in all these fermented milks. The strain obtained 
from dahi appeared to be particularly active, grow- 
ing with much vigor and producing lactic acid very 
freely. 

"People eat wheat, Indian corn, and millet seed 
breads. The first named is supposed to be consti- 
pating, and the last two laxative." — W. L. Pennell, 
M. D., Bannu, India. 

"The coarse wheat and barley flour used for 



BOWEL HABITS OF UNCIVILIZED MAN 387 

their bread is, without doubt, favorable to regu- 
larity."— Edna B. Kuslar, M. D., Phalera, India. 

It is probably not known to most civilized peo- 
ple that wheat as well as rice is very largely used 
in India. England annually obtains enormous 
quantities of wheat from her Indian provinces the 
price of which is such that the Hindu peasant finds 
it necessary to make rice his staple, although con- 
siderable quantities of wheat bread are used by the 
wealthier classes. It is interesting to note, however, 
that the wheat thus used by the natives is chiefly 
employed in the state of coarse meal, rather than 
the fine bolted flour from which two most impor- 
tant elements, cellulose and vitamines, have been 
removed by the milling process. 

"Usual diet of rice with green vegetables, lentils 
or occasionally meat, favors regular motions. Boiled 
radishes favor diarrhoea, and fish favors constipa- 
tion." — Dr. Minnie Gomery, Idlamabad, Kashmir. 

"Diet, rice and vegetables, rarely meat. Rice is 
eaten in great excess. People pass large stools, as 
a lot of rice is ejected. Presumably nitrogen and 
salts are used up and starch excreted." — H. E. 
Rawlence, M. D., Srueagai, Kashmir, India. 

Even remote Kashmir, which has been so little 
in touch with modern civilization, appears to be 
really up to date in matters dietetic. Meat is only 
used occasionally, whereas green vegetables and 
lentils combined with rice constitute the regular 
dietary. 

The passing of quantities of undigested rice is 



388 COLON HYGIENE 

doubtless due to the fact that the rice is imperfectlr 
cooked, a custom very common in rice-eating coun- 
tries, and perhaps a wholesome one. The Scotch 
highlander eats his oatmeal less than half cooked 
and is wonderfully sturdy. Some undigested starch 
in the feces prevents putrefaction. 

The diet being chiefly vegetarian (among the 
Hindus it is so entirely), the large amount of vege- 
tables taken seems to act as the necessary stimulus 
to the bowel." — Robert Madison, M. D., Rajshalu,, 
India. 

"Diet of the people mostly fruit and vegetable. 
Have found that when fruit and salad oil could be 
added, tongues are clean, moist and red. Where 
the white bread is taken in imitation of the for- 
eigner, troubles begin similar to those at home. The 
national custom is to eat but two meals a day." — 
Belle J. Allen, M. D., Baroda Camp, India. 

The observation made by Dr. Allen, that the 
natives of India begin to suffer from constipation 
when they adopt the use of white bread, though 
previously free from this curse of civilization, is 
highly instructive. It is interesting to note that 
the U. S. Agricultural Department is making a 
strong effort to bring to the notice of the American 
the importance of using the whole grain instead of 
discarding the outer portion or bran which is now 
known to contain by far the largest share of the 
lime essential for perfect nutrition as well as the 
highly essential vitamines. It is also interesting to 
note that though the native of India as well as of 



BOWEL HABITS OF UNCIVILIZED MAN 389 

most other countries of the globe eat but two meals 
a day, the prevailing bowel habit among these peo- 
ple is two or three movements daily. More fre- 
quent meals should give rise to more frequent move- 
ments and would doubtless produce this effect in 
this and most civilized countries were it not for the 
highly concentrated and highly constipating char- 
acter of the diet. 

"Motions are large, bulky and not formed, but 
pultaceous. People of these parts eat largely of 
ground wheat and vegetables, not much meat. Hin- 
dus seldom eat flesh." — A. H. Browne, M. D., Am- 
ristsar, India. 

"Meat tends to constipate; vegetables and milk 
tend to loosen." — M. M. Brown, M. D., Sargodha, 
Punjab, India. 

Dr. Brown as well as other close observers of the 
relation of diet to health among people of simple 
habits notes the effects of a meat diet in producing 
constipation. The reason for this as indicated else- 
where is that a meat diet produces colitis and in- 
testinal putrefaction. 

"People coming from the interior are much more 
regular than those living in Smyrna, where more 
meat is eaten than in the interior. After some time 
in Smyrna, such people tend to become less regular." 
— D. McKenzie Newton, M. D., Smyrna. 

"The use of peanuts in all forms, and the eating 
of cooked green leaves of several kinds, used daily 
keeps their bowels in good shape." — A. Sims Roma, 
M. D., Ferrovia, Italy. 



390 COLON HYGIENE 

"On the ordinary native diet there is scarcely 
ever any constipation. On other diet, occasionally." 
— E. MacKenzie, M. D., Hog Harbor, Santo, New- 
Hebrides. 

Rare Occurrence of Cancer and Appendi- 
citis Among Primitive Tribes 

It is the universal testimony that cancer and ap- 
pendicitis are extremely rare. Doctor Shepard, of 
Aintab, Turkey, who has had an enormous practice 
among the Turks for more than a quarter century, 
and is perhaps recognized as the leading abdominal 
surgeon of the Orient, writes: 

"There is relatively very little appendicitis here. 
I do from 500 to 600 important surgical operations 
a year, but only six to eight appendectomies. Can- 
cer of the intestinal tract is quite rare (as are all 
forms of cancer), although ulcer of the stomach is 
common." 

Dr . W. W. Peter, of Shanghai, says, "I never 
heard of appendicitis in a Chinaman." 

The fact that cancer is a disease peculiar to ad- 
vanced civilization is clearly shown by the replies 
received from one hundred and twelve physicians 
located in the following countries: Mexico, Pales- 
tine, Arabia, Turkey, Egypt, South Africa, East 
Africa, Central Africa, Nigeria, Japan, Syria, Ko- 
rea, Persia, Siam, India, Asia Minor, New Hebri- 
des. Forty-three of the one hundred and twelve 
reported that they had never seen cancer of the 
bowels. Nine physicians from different parts of 



BOWEL HABITS OF UNCIVILIZED MAN 391 

Africa, the west coast, Tunis, Nigeria, Rhodesia, 
Uganda, East Africa, British Central Africa, the 
Portuguese Congo and Belgian Congo all report 
having never seen a case of cancer of the bowels 
among the natives. 

Primitive Remedies for Constipation 

The following extracts from replies to our ques- 
tionaire illustrate the habits of people in relation 
to bowel movements and the simple but often highly 
sensible methods employed by them for relief: 

"The chief duty of the Indleburds, or priestly 
caste, is the care of such matters (the movement 
of the bowels). A fine is levied in case of neglect." 
—P. N. Darling, M. D., India. 

The observation of Dr. Darling that one of the 
duties of the priest in India is to educate the people 
in reference to the proper care of the bowels is 
highly suggestive. In this country, the subject of 
bowel hygiene has been so universally neglected that 
even parents are quite ignorant concerning the bowel 
habits of their children and often allow them to 
drift into diseased conditions, the evil effects of 
which are felt throughout their entire lifetime. 
Physical, mental and moral evils resulting from 
constipation are so great that it is not an exaggera- 
tion to say that teachers as well as preachers could 
not make a better use of a portion of their time 
and talents than by the education and training of 
the children in the proper care of the colon. 

"The natives give prompt attention to the bowels. 



392 COLON HYGIENE 

I have again and again had it given me as a reason 
for not living in Aden, that people had there to go 
to the closet in order to evacuate their bowels, 
rather than relieve themselves any place, as this was 
only permitted for children." — John C. Young, 
M. D., Sheikh Othman, Aden. 

The above observation by Dr. Young affords 
powerful testimony to the importance attached by 
the Arabs to the prompt response to the call of 
nature for evacuation of the bowels. 

Dr. Davidson of Travancore, India, says: "Ap- 
pendicitis very rare here. Only about six cases out 
of at least 1,000 major operations." 

Dr. Davidson's experience in meeting only six 
cases of appendicitis among a thousand major op- 
erations is striking evidence of the rarity with which 
appendicitis occurs among non-flesh eating people. 
This observation agrees with that of Dr. Senn who 
noted the absence of appendicitis among the vege- 
table-eating natives of the east coast of Africa. An 
examination of the annual report of the Mayo 
Clinic shows 19 per cent of all cases examined to 
be suffering from appendicitis, and at operation the 
appendix was found diseased and requiring re- 
moval in 21 per cent of all cases operated, whereas, 
Dr. Davidson found in India only six tenths of 
one per cent, a frequency thirty-five times less. 

"No instruments used; people generally boil mo- 
lasses (not maple, but grape juice) and common 
salt together to the consistency of wax, and make 



BOWEL HABITS OF UNCIVILIZED MAN 393 

suppositories to apply per rectum." — S. C. Kaval- 
gian, M. D., Ada Pazar, Asia Minor, Turkey. 

"In cases of constipation or obstruction, very 
forcible measures are employed, such as massage, 
kneading the abdominal wall and exerting pressure 
upon the abdomen, and even kicking." — E. Mar- 
garet Phillips, M. D., Ping Yin, China. 

"Brown sugar is the laxative usually relied 
upon."— Walter W. Williams, M. D., Yung-an 
Fookin Pwo., China. 

The above observations in China and Turkey 
show the sagacity of primitive people in discovering 
simple food remedies for constipation. When taken 
in large quantities, sugar produces laxative effects, 
not only because of its specific stimulating effect 
upon the intestine but because of the stimulating 
effect of the lactic acid produced by the fermenta- 
tion of the sugar in the colon. 

"For relief of constipation a sort of large rolling 
pin is freely rolled up and down the abdomen while 
the patient is lying supine." — H. G. Barrie, M. D., 
Kuling, China. 

The use of the rolling pin as a means of reliev- 
ing constipation is an original Chinese invention, 
although a cannon ball as well as various kinds of 
apparatus have been long in use in this country as 
a means of mechanically stimulating the bowels to 
activity. 

"They use a smooth stalk of millet to stimulate 
the lower bowel." — Elizabeth Beatty, M. D., 
Kwangning, Manchuria, China. 



394 COLON HYGIENE 

Mechanical stimulation of the rectum has long 
been known to be a powerful means of exciting 
peristalsis, but the method is not to be recom- 
mended because of the danger of producing in- 
flammation and infection of the rectum, the result 
of which might lead to hemorrhoids, fissure or ab- 
scess, inducing fistula. 

"A very crude method for giving an enema is 
to take a small slender piece of bamboo for a nozzle 
and a bag made of pig gut, and use it as a syringe." 
—William M. Berss, M. D., Chenchow, South 
Hunan, China. 

"They have no instruments, but often use honey 
suppositories." — W. H. Park, M. D., Soochow, 
China. 

"They have a funnel-shaped enema which is be- 
ing displaced by European bulb syringes." — J. Da- 
vidson Frazier, M. D., Resht, Persia. 

"The people have few or no remedies, save the 
drinking of a large quantity of hot water, which 
they often do when conscious of the need, and with 
quite good effect." — H. W. Schwartz, M. D., 
Yokohama, Japan. 

"Massage is employed ; drugs very rarely." — 
Walter Virden, M. D., Rhodesia, South Africa. 

"Enemata given in the knee-elbow position with 
a funnel made of a leaf, and a pipe made of a 
gourd or vegetable stump." — J. Howard Cook, 
M. D., Fort Portal, Uganda Protectorate, East 
Africa. 

It is interesting to note that even the mem- 



BOWEL HABITS OF UNCIVILIZED MAN 395 

bers of savage tribes are acquainted with the value 
of the enema and have been able to improvise 
means for the getting of water into the bowels. 
Some of the means employed are like the above 
very highly ingenious. It is also interesting to 
learn from the observations of Dr. Cook of the 
employment of the knee-elbow position by the na- 
tives of Uganda. The credit for the invention of 
the knee-elbow position has been given to an Amer- 
ican physician. It seems, however, that in this 
particular civilized people are as in many other 
ways in matters pertaining to physical welfare, 
easily outdone by the natives of many primitive 
tribes. 

" Roots are sometimes cooked in water and .given 
as an enema by means of an ox horn with perforated 
end — large quantity poured in. In the Northern 
Transvaal purgatives are not required. Enema ap- 
pliances not known." — Neil Macvicar, M. D., 
Lorendall, South Africa. 

"The natives regularly use enemata, introduced 
with gourds." — D. Robertson, M. D., Itu, South 
Nigeria. 

"They have medicines for use as purgatives, and 
also use enemas, which are administered by means 
of a sort of gourd with long neck. The gourd is 
filled, and the water flows in by gravitation. The 
patient lies prone." — E. C. Sirley, M. D., W. Coast 
of Africa. 

"The use of common soap passed up into the anus 
or some similar substance is often used by the na~ 



396 COLON HYGIENE 

tives of this country to overcome constipation." — 
W. O. Ballantine, M. D., Rahuri, Western India. 

"Soap suppositories is a common native remedy ; 
enemas are never used; they consider it shameful. 
Massage of the abdominal wall is practiced, too." — 
R. T. H. Cox, M. D., Persawan, N. India. 

The Hindu mother knows the value of the sup- 
pository as a remedy for infants as well as does the 
American mother. Experience is a wonderful 
teacher and in this school the most ignorant savage 
mother has just as good an opportunity to learn 
and make advancement as the mother of the most 
highly civilized land. 

"A smack in the stomach with a colo spade is 
often used, and is invariably productive of a profuse 
and continued motion. Some of the hill tribes carry 
under the left arm pit finely engraved brass tongs 
for the purpose of extracting in their entirety the 
masses of fecal matter. These are shaped by the 
women of the tribe, and are used in their war 
catapults in tribal warfare." — P. N. Darling, M. 
D., India. 

This drastic method of stimulating bowel action 
may sometimes produce injury, but could not pos- 
sibly be more productive of mischief than is the 
common, almost universal, use in all civilized coun- 
tries of laxative mineral waters and drastic cathar- 
tic remedies of all sorts. 

"The population generally deal largely in drastic 
purgatives. A man will take a month's leave from 
work for nothing more than a course of purgation, 



BOWEL HABITS OF UNCIVILIZED MAN 397 

often very severe." — F. V. Thomas, M. D., Palwal, 
near Delphi, India. 

This method of dealing with constipation could 
scarcely be more injurious than the continued use 
of stomach and colon irritating drugs. As Von 
Noorden well says, "nothing is so bad as the 
chronic use of laxative drugs." 

"The native position, squatting at stool, with 
front of thigh against the abdomen, encourages 
evacuations." — W. J. Maule, M. D., Miraj, India. 

The squatting position in moving the bowels ap- 
pears to be universal among all people with the 
exception of those who call themselves civilized. 
It is singular indeed that in relation to this most 
important function of the body the wildest and most 
unsophisticated natives are really in advance of the 
most highly civilized people. The value of the 
squatting position as a means of relieving the bowels 
has been recognized for years but the knowledge 
has had little influence upon the habits of the peo- 
ple in this particular. It is pointed out elsewhere 
in this work how the objectionable features of the 
ordinary closet seat may be overcome by elevating 
the feet upon a stool eight or ten inches high placed 
in front of the closet seat. 

"The position in which the native helps his ex- 
pulsion of feces from colon and rectum is this: he 
sits on his haunches and presses the left side of the 
lower abdomen with the hand or a bunch of cloth." 
— T. Davidson, M. D., South Travancore, South 
India. 



398 COLON HYGIENE 

The practice above referred to by Dr. Davidson 
is interesting evidence of the East Indian's capacity 
for intelligent observation. The descending colon 
and pelvic colon are located in the lower left side 
of the abdomen and pressure just at this point raay 
be of the greatest value in aiding evacuation of the 
bowels. The writer has for many years recom- 
mended patients to assist themselves when neces- 
sary by pressing firmly with the closed fist or with 
both fists upon the left side of the lower abdomen. 
Deep pressure made at this point will often arouse 
the lower bowel to immediate action, causing in- 
stantaneous expulsion of gas and in many cases 
within a few seconds a large evacuation of retained 
fecal matters. The use of a bunch of cloth for the 
purpose of increasing the pressure is an original in- 
vention of the East Indian and is highly suggestive. 
A patient recently reported to the writer the dis- 
covery that a newspaper folded into a round mass 
serves an excellent purpose for making compression 
over the pelvic colon. 

"The use of a piece of oiled soap is common, 
which may have been learned from the English; 
an oiled rag is used, too." — A Missionary Physi- 
cian of India. 

For more than thirty years the writer has made 
occasional use of an oiled ball of cotton or of a 
cheese cloth pledget saturated with oil and placed 
in the rectum at night as a means of combating cer- 
tain forms of constipation. The results have been 
very excellent. Saturation of the pledget with a 



BOWEL HABITS OF UNCIVILIZED MAN 399 

culture of the Bacillus Bulgaricus is still more ef- 
fective in some cases. 

"The chief practice is the habit of squatting at 
stool. Have had patients leave the Hospital be- 
cause they could not have a normal movement with- 
out their own kind of commode. Complaints ceased 
with a native place provided." — Belle J. Allen, 
M. D., Baroda Camp, P. O., India. 

An opening in the floor over which the user 
squats is the provision made for bowel evacuation 
in many parts of France, as well as in Oriental 
countries. Even in Paris, as recently as twenty 
years ago, the writer found this arrangement in use 
in the small hotels of the suburbs of the city. It 
is interesting to note that Dr. Allen's patients were 
willing to forego the advantages of hospital care 
rather than suffer the serious consequences of dis- 
turbed bowel action from interference with the 
normal mode of defecation. 

A missionary physician writing us from South 
Africa related the following incident as an illustra- 
tion of the care which the natives take to secure free 
movement of the bowels. Said the doctor, "A na- 
tive called on me yesterday morning and asked for 
medicine to relieve a dreadful constipation. I said 
to him, "When did your bowels move last?" He 
replied, "This morning, Doctor." "But I under- 
stood you to say you were constipated." "Yes," 
replied the native, "I am horribly constipated. My 
bowels only move once a day." 

Since the publication of the first edition of this 



400 COLON HYGIENE 

work the writer has learned from Dr. Wilfred 
Grenfell, of Labrador, that it is the custom in that 
country to feed reindeer moss to the dogs that are 
used almost exclusively for transportation. After 
mixing with oil the moss is eaten by the dogs with 
great avidity and they appear to thrive upon it. It 
is strange, indeed, that civilized man should be 
about the only creature among the members of the 
animal kingdom who neglects to supply his alimen- 
tary canal with the material necessary to supply the 
intestine with the normal stimulus to action. In 
civilization, domestic animals fare better than hu- 
man beings in this regard. When the horse, ox, or 
cow loses appetite and becomes constipated, bran 
mash is the farmer's ready and efficient remedy. 
But strange to say the farmer never thinks of giving 
himself the benefit of this simple and natural rem- 
edy, but instead dopes himself with purgative pills 
or mineral waters which ruin his digestion, spoil 
his kidneys, increase constipation, and ultimately in- 
duce colitis, one of the most common and most for- 
midable of all the evil effects produced by chronic 
constipation. 

THE COLON CODE 

1. Move the bowels at least three times a day. 
(See pages 211, 212,219.) 

2. Answer the "call," even the slightest, at once. 
Delay of five or ten minutes may be disastrous. 
(See pages 42-50, 122-124, 208.) 

3. Give the bowels an opportunity for evacua- 



THE COLON CODE 401 

tion on rising, at bedtime, and after each meal, 
even if there is no call. (See pages 40-50.) 

4. Allow sufficient time for complete and thor- 
ough evacuation of the colon. (See pages 125-128.) 

5. If the "call" returns after a movement, make 
a second or even a third visit to the toilet. (See 
page 214.) 

6. Place a stool in front of the closet seat to 
raise the feet. (See page 128.) 

7. Eat laxative food at every meal. A single 
omission may upset the bowel system for several 
days. (See pages 220-234.) 

8. If necessary to secure three full evacuations 
daily, take a tablespoonful of bran, or one-third of 
an ounce of agar-agar, and half an ounce to an 
ounce of white Russian paraffin oil at each meal. 
(See pages 231-239.) 

9. Eat regularly and avoid concentrated foods. 

10. Change the intestinal flora by the fruit reg- 
gimen or the milk regimen (186-188). The consti- 
pation will not be permanently cured so long as the 
stools are putrescent or very foul smelling. 

11. Drink two or three quarts of water daily, 
one or two glasses of cold water at bedtime and the 
same on rising. (See pages 111, 112, 118.) 

12. Take deep breathing and abdominal exer- 
cises daily. (See pages 69, 84, 114-116, 272-298.) 

13. Wear loose clothing and if the abdomen sags 
wear a spring supporter constantly when on the 
feet. (See pages 84, 203, 298.) 



402 



COLON HYGIENE 



14. If necessary, use an enema after breakfast — 
three pints of water at 80° to 70° F. A smaller 
enema of cool water (one-half to one pint) may be 
used after each meal or after dinner and at bed- 
time to establish the three-a-day rhythm. (See page 
312.) 

15. A small enema (half pint of tepid or cool 
water at bedtime often secures a good morning 
movement. An enema of a few ounces of paraffin 
oil (four to six) may be used to combat dryness of 
the stool. (See page 312.) 

16. In many cases of colitis, with spastic contrac- 
tion of the descending or pelvic colon, a complete 
movement rarely occurs. The feces are slowly 
pushed through the constricted bowel. In such 
cases what may be termed supplementary bowel 
movements are necessary. A few minutes after the 
movement, or it may be an hour after, a slight 
"call" may be experienced. This should be re- 
sponded to at once, and even if the call is repeated. 
When the bowels do not move satisfactorily, it is 
well to wait for several minutes, meantime occupy- 
ing the mind with reading the morning paper, per- 
haps. This affords time for a new instalment of 
waste material to be pushed down from the upper 
part of the colon. 

17. A very hot sitz bath for two to five minutes, 
or a hot fomentation, taken before breakfast, is an 
excellent means of relaxing the contracted colon in 
cases of colitis, and so preparing the bowel for sl 

pod after-breakfast evacuation. 



COLON CODE 403 

18. Fruit on rising, and on going to bed, may be 
taken when necessary as an aid to other measures. 
One or two oranges, an apple, a couple of plums, or 
a dish of berries eaten without cream (malt sugar 
may be added), or a bunch of ftresh grapes are suit- 
able for this purpose. The fruits named do not tax 
the digestive organs because they contain no fat, 
very little protein, and no raw starch, the starch 
having been digested by the process of ripening. 
They are all rich in vitamines and highly refresh- 
ing. When taken into the stomach they induce a 
lively peristalsis which is continued down the in- 
testine and helps to advance the fecal mass toward 
the point of exit. The fruit taken on rising helps 
to secure a full bowel movement after breakfast. 
The fruit at bedtime prepares the way for a bowel 
evacuation on rising. 

THE CARMINE TEST FOR INTESTINAL 
MOTILITY 

The length of time required for the passage of 
material through the alimentary canal may be 
readily ascertained by the administration of some 
substance which will give to the intestinal contents 
a decided color which can be easily recognized. 
Animal charcoal, carmine and even highly colored 
fruit, such as the huckleberry, may be used for this 
purpose. It is necessary, of course, that while tak- 
ing the test care should be taken to avoid taking 
foods of such a color as might lead to confusion 



404 COLON HYGIENE 

with the color of the test substance. In applying 
the test, two capsules containing five grains each of 
carmine are usually given at breakfast, say at 8 A. M. 
Each stool is afterwards examined and the time 
noted when the red color of the carmine appears. 
The examination of the stools continues until the 
color disappears. This time is also noted. 

From a large number of observations, several 
hundred, it has been determined that in a normal 
person the color should make its appearance within 
twelve hours from the time it has been taken and 
should disappear within twenty-five hours. In a 
considerable number of persons the color appears 
in less than twelve hours and disappears in eighteen 
hours or even less. It is probable that the shorter 
periods mentioned are more nearly the normal and 
that the periods of twelve hours for appearance and 
twenty-five hours for disappearance should be re- 
garded as the extreme limits of normal motility. 
The normal time for the stomach to empty itself is 
four to five hours. At the end of seven or eight 
hours the small intestine should be emptied and the 
unutilized food residues should be found wholly in 
the colon. These residues normally find their way 
to the rectum in three or four hours more, and there 
seems to be no good reason why unusable and pu- 
trescible materials should be retained for a longer 
time to undergo decomposition and contaminate the 
blood through the absorption of the poisonous prod- 
ucts. 



COLON CODE 405 

In barn yard fowls the length of time required 
for food to traverse the entire alimentary canal is 
three hours and a half. In some animals the period 
is not more than one hour. 

In cases of chronic constipation the time for the 
appearance and the disappearance of the test color 
is very greatly lengthened. The time of appearance 
is not infrequently prolonged to twenty-four or 
thirty-six hours and the time of disappearance is, 
in a large proportion of cases, forty-eight hours or 
more. Seventy-two hours or three days is not an 
uncommon observation and the writer has observed 
cases in which the color did not disappear until the 
end of four days and in one case, six days. Cases 
are occasionally observed in which the color dis- 
appears and then reappears. The explanation of 
this circumstance is the existence of a greatly dilated 
cecum in which a portion of a meal may be re- 
tained while the residues of a subsequent meal pass 
over and on to exit. 

By means of the carmine test the degree of stasis 
or stagnation of intestinal contents may be ascer- 
tained and the improvement resulting from diet or 
treatment may be observed. This test is one that 
ought not to be omitted in any case of obstinate 
constipation which does not readily yield to the meas- 
ures applied and it is advantageous in all cases. 



Index 

Abdomen, pain in 137-139 

relaxed, and constipation 84 

weak contraction of 156 

compression-breathing 283 

massage in treatment of constipation 290, 291 

muscles, to strengthen 278 

pouring douche bath 244, 245 

support in spastic constipation 320 

support in treatment of constipation 298 

tenderness of, resulting from constipation 367 

Acids, laxative effects 66, 91 

Adhesions, interference with peristalsis 81 

Agar-agar, how used 233, 234 

in mixed constipation 321 

laxative properties of 62 

Alcohol, constipative effects of 130 

Alternate applications to abdomen, fomentations... 246 

Anal fissure, resulting from constipation 366 

incontinence, resulting from constipation 367 

itching, resulting from constipation 366 

spasm, resulting from constipation 366 

Anger, and constipation 75, 139 

Appetite juice, necessity of 94, 95 

lack of 135-137 

Arc light, in spastic constipation 319 

Arteriosclerosis, in constipation 152 

Autointoxication, intestinal, cause of 159 

Bacillus bifidus 166, 167 

bulgaricus 168-173 

Welch's 54- 

Backache, resulting from constipation 350, 351 

Bacteria, acid forming 166-173 

changing intestinal 186 

putrefactive action in colon 53, 55 

putrefactive effects of 168, 169 

of intestine 163-173 

406 '• 



INDEX 407 



Baths, abdominal pouring douche 244, 245 

alternate applications to abdomen 246 

cold douche 243 244 

cold sitz, constipative effects 76 

exercise 242, 243 

fomentation to abdomen 246, 247 

hot bath and hot douche 248 

hot sitz 248 

hot sitz and cold pour 245 

in latent constipation 317 

in spastic constipation 318 

in treatment of constipation 241-248 

rubbing cold sitz bath 245 

wet girdle 246, 247 

sedative sitz bath 246 

simultaneous hot and cold douche 244 

Bile, composition of 60 

relation to constipation 59, 60 

Blood-vessels, diseases of 179, 180, 342 

Bowel habits of primitive tribes. 370-399 

in Aden 391 

in Africa .376, 394, 395 

in China 379, 380, 386, 393, 394 

in Egypt 385 

in India 386, 391, 392, 396, 398 

in Italy 389 

in Japan 394 

in Kashmir 387 

in Korea 377, 378 

in Mukden 386 

in New Hebrides 390 

in Palestine 385 

in Persia 383, 384, 394 

in Smyrna 389 

in South Nigeria 395 

in Syria 375, 376 

in Turkey 381, 382, 393 

Bowel kneading at stools, in treatment of 

constipation 294 

Bran-fruit diet 191, 193 

Bran, how to sterilize 237 

how to use 236, 240 



408 



INDEX 



Bran, recipes. 237-240 

gems, recipe 240 

bran and Granola mush, recipe 238 

bran and graham biscuits, recipe 239 

Breathing exercise 277 

incorrect 114-117 

Brose 240 

Bulk, afforded by vegetables 90 

influence on peristalsis 60- 65 

lack of 90, 91, 99-101 

Buttermilk, laxative effects of 101, 102 

"Call," importance of 119-124 

Cancer, of colon, from constipation 153, 349 

Cannon ball, in treatment of constipation 295 

Carmine motility test 403 

Catarrhal colitis, resulting from constipation. . .322-329 
Cecum, massage in treatment of constipation. .291, 292 

Cellulose, amount in various foods 228-230 

Ceylon moss, laxative properties of 62 

Chairman unhealthful 115 

Changing intestinal flora 186, 194 

Chest raising exercise 278 

Clothing, in treatment of constipation 203 

Coffee, constipative effect of 110 

Cold douche and intestinal activity * 70 

Cold douche bath 97-99, 243, 244 

Colic, resulting from constipation 368 

Colitis, muco-membranou^, resulting from 

constipation 338, 339 

Colitis, resulting from constipation 322-32!? 

when observed 200 

treatment of 330-336 

Colon, adhesions 81 

atony 136, 137 

code 400-403 

compressing the 281 

contraction of 80, 140, 141 

evacuation of 34- 36 

excitant influences 58- 72 

function of 23- 28 

length in animals 9 

movements of 28- 30 

obstruction of 12-140 



INDEX 409 



Colon, pelvic loop 31 

phy§iology of 17-36 

position of 19 

replacing of 283 

splenic flexure I 146 

usefulness of 9 

weak contraction of 156 

Compression of waist 84 

Concentrated foods, constipative effects of... 73, 74, 81 

Condiments, injurious effects of 106-108 

Constipation, abdominal supporter in treatment of.. 298 

baths in treatment of 241-249 

causes of 12, 78-87, 134 

cumulative 308-314 

curability of 203-211 

curable without drugs 12 

diet in. . . 218, 240, 304-308 

exercise in treatment of 272-290 

influences which promote 73-77 

latent, treatment of 315-317 

massage, in treatment of 290-297 

mechanical effects of 150 

treatment of 201-217 

mixed cases 320, 321 

reflex 138 

reflex, treatment of 318-320 

simple 303-308 

symptoms in cumulative 195-197 

symptoms in latent 197-199 

symptoms in simple 195, 196 

symptoms in spastic. 200 

spastic, treatment of 318-320 

use of paraffin oil 260-271 

Cooked foods, excessive use of 95-97 

Corset and constipation 84 

Cream, skin 355 

Cumulative constipation, treatment of 308-314 

Deep breathing exercises. 280 

Defecation, special exercises to aid 289 

Descending colon, contraction of 81 

Diabetes, amount of water needed 112 

one cause of 330 



410 INDEX 

Diaphragm exercise 284 

Diaphragm, weakened 155 

Diathermy, in constipation 302 

Diet, Bran-fruit 191-193 

in mixed constipation 321 

special milk 188-191 

Digestion, time table 32 

Digestive organs, disorders of 179 

Diseases resulting from constipation 338-368 

Diverticulitis, resulting from constipation 348 

when operable 210-211 

Drugs, constipative effects of 131-135 

injury from 257-260 

useless 12-13 

Dryness of diet, effects of Ill 

Duodenum, infection of 329 

catarrh of 329 

ulceration of 329 

Eating and constipation 87 

Eating, laxative effects of 67 

Eczema, resulting from constipation 348 

Electricity and intestinal activity 68, 69 

in treatment of constipation 300-302 

Emotions, depressing, constipative effects of.. 75, 76, 139 

Enema, in cumulative constipation 310-313 

in latent constipation 317 

in spastic constipation 318, 319 

alum 255 

cold rectal douche 256 

cold water 252, 253 

glycerine 255 

hot saline 252 

hot soap 251 

hot water 251 

how given 249-251 

oil 253, 254 

paraffin oil 255 

sugar and water 254 

Evacuation, mechanism of 34-36, 40-50, 153-158 

Exaggerated knee-chest breathing 284 






INDEX 41 1 

Exercise and intestinal activity 70 

bath 242, 243 

effects of 117, 118 

program 290 

Exercises, abdominal muscles 278, 283 

automatic 300, 301 

Exercises, breathing 277, 280, 281, 283, 284 

chest raising 278 

colon 281, 283 

diaphragm 284 

hill climbing 272 

hips rolling 285 

horseback riding 273 

inclined plane 281, 282 

leg raising 284 

medicine ball 273 

posture 274-277 

rocking 279 

rocking chair 277, 278 

rolling 279 

rowing 273 

running 280 

squatting 280 

static 285, 286 

tennis 273 

tension 287, 288 

trunk raising 279 

trunk twisting 285 

work . . . 274 

Exophthalmic goitre, resulting from 

constipation 351, 352 

Eyes, disorders of 180, 181 

Fallopius, quoted 258 

Fasting, constipative effects of 75, 103-106 

Fats, and intestinal activity 66 

Fear, and constipation 75, 139 

Fecal fever, resulting from constipation 359, 360 

tumors, resulting from constipation 340 

Fever, fecal, resulting from constipation 359, 360 

Fissure, anal, resulting from constipation 364 

Flatulency, resulting from constipation 360, 363 

Fomentation to abdomen 247" 



412 INDEX 

Food gates, location of 17 

Food, insufficient amount of 99-14)1 

tube, structure of 18 

Foods, atoxic and antitoxic 221-240 

laxative 220, 221 

uncooked 222-226 

Fruit acids, laxative effects of 66, 74, 91 

regimen 191-194 

Gall-bladder, diseases of, resulting from constipation 345 

infection of 329 

Gases, and intestinal activity 67 

Gas, formation in intestine 175 

Gastric disorders, resulting from constipation 341 

Generative organs, disorders of, resulting from 

constipation 358 

Glycerine, enema 255 

Goitre, exophthalmic, resulting from constipation 351, 352 

Gout, rheumatic, resulting from constipation 353 

Graham and bran biscuits, recipe for 239 

Graham bread, recipe for 238 

Granola and bran mush, recipe for 238 

Habits, in treatment of constipation 202, 203 

relation to constipation 87 

Headache, caused by constipation 150, 151, 346, 347 

Heart disorders, resulting from constipation 342 

Heat, and intestinal activity 70 

constipative effects of 76 

effects of 97-99 

Hemorrhoids, resulting from constipation 365 

Hepatic flexure, delay at 145, 146 

Hill climbing 272 

Hips rolling. 285 

Horseback riding ■. 273 

Hot bath and hot douche 248 

drinks, constipative effects of 76, 97, 98 

foods, constipative effects of 97, 98 

sitz and cold pour bath 245 

sitz bath 248 

Houston's valves, thickening of 148 

Hygiene, in treatment of constipation 202, 203 

Iliac colon, construction of » ^1 



INDEX 413 

Ileocecal valve, contraction of 144, 145 

incompetent 82 141, 149 

structure and function of 27, z8, 37- 39 

Incontinence of anus 367 

Indians, Alaska, diet of 63 

Hopi, diet of 64 

Indians, Malkelkos 87 

Orinoco, diet of 64 

South American 164 

Insomnia, resulting from constipation 345 

Intestinal canal, structure of 18 

content, composition of 53- 56 

content, consistency of 26 

flora, changing the 186-194 

Intussusception of colon 153 

Irregular meals, injury of 108, 109 

Itching anus, resulting from constipation 366 

skin, resulting from constipation 356 

Isinglass, Japanese 62 

Japanese isinglass, laxative properties of 62 

seaweed, how used 233, 234 

seaweed, laxative properties of 62 

Joints, diseases of 181, 182 

Kidney, diseases of, resulting from constipation. 343, 344 

movable, resulting from constipation 344 

Kinks, cause of constipation 148, 149 

resulting from constipation 368, 369 

Knee-chest breathing exercise 280, 281 

Latent constipation, treatment of 315, 317 

Laxative foods 220, 221 

Leg raising exercise 284 

Liquids, constipative effects of 73 

need of in diet 111-115 

Liver, aid to peristalsis 59- 60 

diseases of, resulting from constipation .... 345 
enlargement, resulting from constipation... 339 

how crippled 161-163 

Locomotor ataxia, caused by constipation 158 

Massage and intestinal activity 69, 70 

in cumulative constipation 314 

in latent constipation 317 

in spastic constipation 319' 



414 INDEX 

Massage, abdominal 290, 291 

bowel 294 

cannon ball 295 

cecum 291, 292 

mechanical 293 

pneumatic compression 297 

Massage, shot bag 296 

weighted compress 295, 296 

Mastication, excessive 89, 90 

Meals, number and size of 235, 236 

irregularity of 108, 109 

regularity of 211-213 

Meat, constipative effects of 77, 91, 92, 103 

Mechanical massage, in treatment of 

constipation 293 

Medicine Ball 273 

Milk, cause of toxemia 160 

constipative effects of 92, 93, 101 

Motility test 403 

Muco-membranous colitis, caused by consti- 
pation 338, 339 

Muscles, degeneration of 181, 182 

Myxedema, resulting from constipation 352, 353 

Mush, constipative effects of 74 

Nerves, disorders of 180 

Neuralgia, caused by constipation 150 

Nutrition, disturbance of 183 

disturbance in infants 347 

Obesity, amount of water needed 112 

tendency to constipation 106 

Obstruction of colon 140 

Osteo-arthritis, resulting from constipation 353 

Pain, constipative effects of 75 

Pancreas, _ infection of 330 

chronic inflammation of 330 

Paraffin oil, action of 260-271 

enema 255 

in cumulative constipation 314 

Russian 67 

when used 308 

Pelvic colon, delay in 33 

how filled 31, 43 



INDEX 415 

rectal junction, delay at 147 

Peristalsis, of transverse colon 29 

propulsive 29 

molding ^9 

reverse 29 

Perspiration, excitant of peristalsis 76 

Phctophore, in spastic constipation 319 

use of, in constipation 249 

Pigmentation of the skin, resulting from 

constipation 353, 354 

Pituitary body, intestinal stimulus 60 

Pneumatic compress, use of in treatment of 

constipation 297 

Posture and intestinal activity 70 

importance of correct 114-116 

to correct sitting 276, 277 

to correct standing 274-276 

Proctitis, resulting from constipation 336-338 

treatment of 337 

Psoriasis, resulting from constipation v 356 

Psychic influences and intestinal activity 68 

Pylorus, function of 28 

Rachitis, resulting from constipation 347 

Raw foods 222-226 

beneficial effects of 95, 97 

Rectal prolapse, resulting from constipation 366 

Rectum, structure and function 20, 21 

Redundancy, of colon 82 

Rheumatic gout, resulting from constipation... 353 
Rheumatism, chronic, resulting from constipation 353 

Rocking chair exercises 277, 278 

Rolling exercise 279 

Rowing 27 

Royal Society, discussion of toxemia 177-193 

Rubbing, cold sitz bath 245 

Running, on all fours 280 

Russian paraffin oil 260-271, 308 

Sauer-kraut, used by Russians 90 

Sedative sitz bath 246 

Senility, resulting from constipation 342, 343 

Shot bag, use of in treatment of constipation. 296 

Simultaneous hot and cold douche bath 244 



416 INDEX 

Sinuisoidal current, in cumulative constipation.. 313 

in latent constipation 317 

Sitz baths, hot sitz 248 

hot sitz with cold pour 244 

rubbing cold sitz 245 

sedative sitz 246 

Skin cream, recipe 248 

diseases, resulting from constipation. . .181, 353, 367 

Sleep, constipative effects of 76 

Sleep, irregularity of 113 

posture during 215-217 

results of loss of 214,215 

Small intestine, function of 27 

infection of 329 

structure of 21 

Spasm, anal, resulting from constipation 367 

Spastic constipation, treatment of 318-320 

when observed 200 

Special exercises, to aid defecation 289 

Spleen, a stimulant of peristalsis 60 

enlargement, resulting from constipation . . . 339 

Splenic flexure, delay at 146 

Squatting exercise 280 

Static exercise 285, 286 

Stomach disorders, resulting from constipation. 341 

Stricture, need of operation 152 

Sugar, and intestinal activity 65 

Surgery, when needed 208, 211 

Tea, constipative effects of 74,110 

Tennis 273 

Tension exercise 287, 288 

Thermaphore, in mixed constipation 321 

use of in constipation 249 

Time Table, of digestion 32 

Tobacco, constipative effects of 129 

Toxemia, intestinal, cause of 159-193 

characteristic effects of 175, 176, 178-186 

discussed in Royal Society 177-193 

Transverse colon, contraction of 81 

Trunk raising 279 

twisting 285 



INDEX 4\7 

Tuberculosis of bowels, resulting from 

constipation 349, 350 

Tumors, fecal, resulting from constipation 340 

Tumor of colon 153 

Ulcer, resulting from constipation 366 

Urinary organs, disorders of, resulting from 

constipation 358 

Vegetable acids, laxative effects of 66- 91 

gelatin, laxative properties of 62 

laxative effects of 101 

use by animals and primitives 61- 65 

Vertigo, resulting from constipation 357 

Vibration and intestinal activity 69 

in cumulative constipation 314 

in treatment of constipation 293, 294 

Volvulus, resulting from constipation 341 

Weighted compress, use of in treatment of 

constipation 295, 296 

Welch's bacillus 54 

Wet girdle bath. 246, 247 

White bread, constipative effects of 91 

^rk 274 



